Abstract:

Diagnosis and treatment of intra-abdominal sepsis caused by bowel necrosis or bowel perforation        LI Shi-kuan，WANG Pei-ge. Department of Emergency General Surgery，the Affiliated Hospital of Qingdao University，Qingdao 266003，China
Corresponding author：WANG Pei-ge，E-mail: pgzyz@163.com
Abstract    Bowel necrosis or bowel perforation，the acute abdomen with high mortality in abdominal surgery，might cause severe intra-abdominal and systemic sepsis. The etiologic diagnosis of bowel necrosis or bowel perforation is essential. Detailed assessment，antibiotic therapy，fluid resuscitation and correcting lactic acidosis should be carried out preoperatively. Pathogenic bacterial evidence may be obtained by ascites fluid culturing. The procedure should be performed in accordance with the damage control surgery principle. The abdominal cavity should be lavaged adequately during surgery. Moreover, fluid replacement, antibiotic therapy，abdominal drainage，maintenance of organ function and nutrition supporting remain the important postoperative approaches. Doctors should set goals to reduce the mortality of bowel necrosis and bowel perforation by early diagnosis and early intervention，intensive perioperative care，effective management of comorbidities and postoperative complications.

Key words: bowel necrosis, bowel perforation, intra-abdominal sepsis

摘要：

肠坏死和肠穿孔病人易并发严重腹腔感染和脓毒症，病死率较高。术前须充分评估病情，给予抗感染、液体复苏、适当纠正乳酸性酸中毒；术中通过腹水培养获得细菌学证据，手术过程要遵循损伤控制外科原则，充分冲洗腹腔；术后继续补液、抗感染、引流、维护重要器官功能和营养支持。通过早期诊断和早期干预、加强围手术期管理、处理合并症和术后并发症以降低肠坏死和肠穿孔所致腹腔感染的病死率。

关键词: 肠坏死, 肠穿孔, 腹腔感染