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    Home > Active Ingredient News > Infection > "Expert Consensus on Multidisciplinary Diagnosis and Treatment of Common Abdominal Infections in Surgery" released!

    "Expert Consensus on Multidisciplinary Diagnosis and Treatment of Common Abdominal Infections in Surgery" released!

    • Last Update: 2021-04-27
    • Source: Internet
    • Author: User
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    Abdominal infection is one of the common clinical acute and critical illnesses, and its diagnosis and treatment involves multiple disciplines.

    "Expert Consensus on Multidisciplinary Diagnosis and Treatment of Common Abdominal Infections in Surgery" reviews the diagnosis, pathogenic detection, surgical and antimicrobial treatment of common abdominal infections in surgery and other clinical hot issues, and proposes recommendations related to diagnosis and treatment based on the level of evidence.

    Regarding the diagnosis and surgical treatment of common abdominal infections, the article mainly proposes the following consensus.

    Acute appendicitis [Consensus 1] Abdominal ultrasound is the first choice for imaging of acute appendicitis, especially for pregnant patients; enhanced CT is available for suspected non-pregnant patients with negative ultrasonography; MRI is available for suspected pregnant patients with negative ultrasound (level of evidence: Medium; Strength of recommendation: Strongly recommended).

    [Consensus 2] Appendectomy is the most effective method for the treatment of acute appendicitis.
    Operate as soon as possible after a clear diagnosis; if there are no contraindications, laparoscopic appendectomy is recommended (level of evidence: high; strength of recommendation: strong recommendation).

    Upper gastrointestinal perforation [Consensus 3] Upper gastrointestinal perforation mainly manifests as chemical and bacterial peritonitis.
    Auxiliary examinations include blood routine, CRP, upright abdominal X-ray film, abdominal and pelvic CT, etc.
    , ultrasound-guided puncture if necessary ( Level of evidence: high; strength of recommendation: strong recommendation).

    [Consensus 4] The upper gastrointestinal perforation should be actively treated surgically.
    The surgical methods include laparoscopic, open or endoscopic surgery.
    Some patients can be treated conservatively (level of evidence: medium; strength of recommendation: general recommendation).

    Lower gastrointestinal perforation [Consensus 5] The clinical symptoms of lower gastrointestinal perforation progress slowly, manifested as bacterial peritonitis.
    Auxiliary examinations include blood routine, CRP, PCT, abdominal and pelvic CT, upright abdominal X-ray, etc.
    , ultrasound guidance if necessary Under diagnostic puncture (level of evidence: high; strength of recommendation: strong recommendation).[Consensus 6] Perforation of the lower gastrointestinal tract should be actively treated surgically.
    The surgical method is individualized according to the time of perforation and the contamination of the abdominal cavity.
    Laparoscopy or open surgery can be used (level of evidence: medium; strength of recommendation: general recommendation).

    Acute biliary tract infection [Consensus 7] The Charcot triad of abdominal pain, chills, high fever, and jaundice is indicative of acute biliary tract infection, and the diagnosis can be confirmed when imaging examinations suggest bile duct stones or cholangitis (level of evidence: medium; level of recommendation: fair Sexual recommendation).

    [Consensus 8] Biliary drainage should be implemented as soon as possible for acute severe biliary infections, and treatment of the cause can be carried out after inflammation is controlled (level of evidence: medium; degree of recommendation: strong recommendation).

    Liver abscess [Consensus 9] Liver abscess can be diagnosed based on medical history, clinical manifestations and CT scans and other imaging examinations.
    If necessary, ultrasound-guided diagnostic puncture and bacteriological testing (level of evidence: high; strength of recommendation: strongly recommended) .

    [Consensus 10] Ultrasound-guided puncture drainage is the first choice for bacterial liver abscess, and empirical antimicrobial therapy should be performed as soon as possible (level of evidence: medium; strength of recommendation: strong recommendation).

    Local complications of severe acute pancreatitis (SAP) [Consensus 11] Infectious pancreatic necrosis (IPN) should be considered when SAP patients develop symptoms of infection such as fever and abdominal pain (level of evidence: low; strength of recommendation: strong recommendation).

    [Consensus 12] Patients with suspected IPN should undergo inflammatory index testing including PCT and CT examination to assist in the diagnosis (level of evidence: medium; strength of recommendation: strong recommendation).

    [Consensus 13] It is not recommended to routinely perform fine needle aspiration biopsy for patients suspected of being diagnosed with IPN (level of evidence: medium; strength of recommendation: strong recommendation).

    [Consensus 14] The step-up approach is the main treatment strategy for IPN patients (level of evidence: high; strength of recommendation: strong recommendation).

    [Consensus 15] Some patients with IPN can be directly treated with minimally invasive surgery (level of evidence: low; strength of recommendation: general recommendation).

    [Consensus 16] Laparotomy can be used as a supplementary method after the failure of minimally invasive techniques (level of evidence: low; strength of recommendation: strong recommendation).

    [Consensus 17] The timing of minimally invasive surgery intervention is 4 weeks after the onset of pancreatitis (level of evidence: medium; strength of recommendation: strong recommendation).

    [Consensus 18] Percutaneous drainage can be performed early after the diagnosis of IPN is clear (level of evidence: low; strength of recommendation: strong recommendation).

    Pancreatic fistula complicated by abdominal cavity infection [Consensus 19] Pancreatic fistula complicated by pancreatic fistula can be diagnosed if ≥3 days after pancreatic surgery, the amylase concentration in the drainage fluid is 3 times higher than the upper limit of normal serum amylase concentration, and accompanied by any of the following diagnostic criteria Abdominal infection: (1) Postoperative fever, increased white blood cell count (>10×109/L), abdominal pain, bloating, and obvious signs of peritonitis; (2) Ultrasound, CT and other imaging examinations suggest the presence of infectious lesions in the abdominal cavity; (3) Abdominal drainage fluid is purulent fluid, and the bacteriological culture result is positive (level of evidence: low; strength of recommendation: general recommendation).

    [Consensus 20] For patients with pancreatic fistula complicated by abdominal cavity infection, the application of somatostatin drugs can reduce the amount of pancreatic juice after surgery, and adjust the medication time according to the change trend of the drainage volume.
    Generally, it should be applied for 5 to 7 days (level of evidence: high; strength of recommendation) :highly recommended).

    [Consensus 21] For patients with severe infection symptoms and poor conservative treatment effects, unobstructed drainage should be established as soon as possible under the principle of "traumatic progression" (level of evidence: high; strength of recommendation: strong recommendation).

    Postoperative biliary fistula combined with infection [Consensus 22] Imaging examination is of guiding significance for clarifying the diagnosis of biliary fistula and choosing treatment methods.
    It can be selected according to actual conditions and clinical needs (level of evidence: high; strength of recommendation: strong recommendation).

    [Consensus 23] The treatment of biliary fistula complicated by abdominal cavity infection should adopt sequential therapy: first establish sufficient and unobstructed external drainage, and then perform definitive treatment after infection control (level of evidence: medium; strength of recommendation: strong recommendation).

    Anastomotic leakage after gastrointestinal tract surgery complicated with abdominal infection [Consensus 24] Anastomotic leakage after gastrointestinal tract surgery is mainly manifested as chemical peritonitis and/or bacterial peritonitis; auxiliary examinations include blood routine, serum CRP, PCT, abdominal and pelvic CT examination , Gastrointestinal radiography or endoscopy, etc.
    , can be selectively applied according to the condition (level of evidence: high; strength of recommendation: strong recommendation). [Consensus 25] Anastomotic leakage should be adequately drained and treated with anti-infective treatment to reduce leakage of the contents of the digestive tract and promote the healing of the leakage.

    For patients with risk factors for anastomotic leakage, active preventive measures should be taken to reduce the incidence of anastomotic leakage and the severity of its complications (level of evidence: strong; strength of recommendation: strong recommendation).

    Digestive tract perforation and abdominal infection after endoscopy and treatment [Consensus 26] When symptoms and signs such as abdominal pain, bloating, and subcutaneous emphysema occur after endoscopy and treatment, the possibility of iatrogenic gastrointestinal perforation should be considered and promptly performed CT examination confirms the diagnosis (level of evidence: medium; strength of recommendation: strong recommendation).

    [Consensus 27] Endoscopic repair is the main treatment for iatrogenic perforation.
    Laparoscopic or open surgery can be used after endoscopic repair fails (level of evidence: high; level of recommendation: highly recommended).

    [Consensus 28] Before surgery, the patient's condition, lesion size, and depth of invasion should be carefully evaluated, and the indications for endoscopic surgery should be strictly grasped (level of evidence: low; level of recommendation: strongly recommended).

    The above content is extracted from: Chinese Medical Association Surgery Branch, Infectious Disease Evidence-Based and Translation Professional Committee of Chinese Research Hospital Association, Editorial Department of Chinese Journal of Surgery.
    Expert consensus on multidisciplinary diagnosis and treatment of common abdominal infections in surgery [J].
    Chinese Journal of Surgery, 2021,59(3):161-178.
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