Newsletter

[ Vol. 13 No. 3 ] (September - December 2012 )
Nutritional and metabolic care of patients with abdominal infectious catastrophe

Peter B. Soeters
Department of Surgery, Academic Hospital Maastricht (The Netherlands)

Many different aspects of our care determine surgical outcome. Assessment of risk may guide measures that can be taken before surgery to improve outcome, during surgery to limit the risk of complications and after surgery by improving the health state of the patient as well as detecting and treating complications early and diligently.

Prevention/Risk factors for infectious complications:Two major risk factors for postoperative infectious complications consist of loss of body weight (more than 10-15%) and the presence of inflammatory activity, together determining the degree of malnutrition. If possible both aspects should be treated. Mono-organfailure will lead to malnutrition but cardiac, respiratory and liver failure should especially be mentioned as they substantially increase the risk of postoperative complications and mortality.

Surgery:The nutritional state of the patient should determine the extent of the surgery. In patients at high risk “damage control” should be performed, removing the dead/infected/cancerous lesions or performing primary small intervention for instance draining abscesses or restoring bowel passage. After improvement of the health state of the patient definitive (surgical) treatment can be instituted.

Postoperative follow up: After operations early detection of complications is essential to treat adequately and to prevent irreversible deterioration and mortality. To improve rapid and pleasant recovery (ERAS) a team effort has been shown promise. Early nutrition and mobilization are crucial elements of this approach.

Postoperative (infectious) complications:The earlier signs of infectious complications appear, the more severe they will turn out to be, and the more aggressive (early) intervention (re-operation) is necessary. In general symptoms of infection, arising after 5-7 days are less severe and localized because the abdominal contents are “glued” together, localizing leaking anastomoses or iatrogenic bowel lacerations, and allowing local (preferentially radiographic) techniques to treat infection. Surgery at a later time point (after one week) is fraught with damage to the bowel and renewed leakage and infection. 

Definitive surgery:Full recovery of the patient after surgical catastrophy and damage control takes at least 3-6 months but it has been shown in large patient series that the abdomen is accessible again after 6 weeks. If the situation permits a longer wait is advocated by many experts. 

Conclusion:A holistic approach and a team effort are necessary to treat patients with major abdominal catastrophe successfully. Such patients need one or two well communicating and dedicated physicians/surgeons and a team to achieve optimal results.

From  
The 14^th Congress of Parenteral and Enteral Nutrition Society of Asia
“From Nutrition Support to Nutrition Therapy”
October 14-16, 2011, Taipei, Taiwan 
Page: 4-5