Case files Surgery definitions

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abdominal wall
component
separation

technique to separate the anterior and

posterior abdominal fascial layers
followed by lateral release of the anterior
fascial layer. Advancement of the anterior
fascia for closure of mid-line abdominal
defect can then be accomplished. No
prosthetic material used so decreased risk
of infection.

Deep surgical
site infection

infection involving fascia. aka intraabdominal infections in post-op abd

surgery. e.g.: secodary peritonitis, tertiary
peritonitis, intra-abd abscess

Enterocutaneous
Fistula

A direct communication b/w the small

bowel lumen and a skin opening. It can
be the primary process leading to wound
dehiscence, but this complication
frequently develops from wound
dehiscence and direct trauma to
underlying bowel. Can lead to sepsis,
metabolic derangemetns, long-term
disability and mortality

Evisceration

the presence of abdominal viscera

(bowel/omentum) protruding thru a
fascial dehiscence or traumatic injury

Fascia
dehiscence

The disruption of fascia closure w/n days

of an operation; this complication may
occur w/ or w/o evisceration

intra-abdominal
abscess

Defined intraperitoneal collection of

inflammatory fluids, microbes resulting
from host compartmentalizing process in
whihc fibrin depsition, omental
containment, and ileus of the small bowel
localize the infectious material. Cannot
be cleared by lymph system

Post-op fever

oral temp>38-38.5 (100.4-101.3)

Pre-emptive abx
therapy

therapy towards gram - anaerobes in

intra-abdominal abscess.

secondary
microbial
peritonitis

spillage of endogenous microbes into

peritoneal cavity following viscera
perforation. The persistence of this
infection is affected by microbial
inoculum volume, the inhibitory and
synergistic effects of the polymicrobial
environment and host response.
Recurrent infections may result from
insufficient abx therapy or inadequate
source control

sepsis
Severe sepsis
Septic shock

SIRS + source of infection

Sepsis + multi-system organ dysfxn
severe sepsis + hypotension

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superficial
surgical
site
infection

infection above fascia Tx by wound explorations

and drainage. systemic abx if extensive
surrounding cellulitis (>2 cm from incision
margins) or IC patient

surgical
site
infection

Infections involving the skin and subcutaneous

tissue subdivided into superficial or deep
depending on fascial involvement

tertiary
microbial
peritonitis

In pts who fail to recover from intra-abdominal

infections despite surgical/abx therapy b/c of
diminished host response. Usually d/t
opportunistic pathogens like staph epidermidis,
enterococcus faecalis, and candida species