1. Septic Abdomen Surgery
Jayce Lineberger, DVM, DACVS

2. Surgery Outline Common causes Goals Surgical approach
Surgical techniques  
Drains
Post-op

3. Common Causes Gastrointestinal tract
Dirty or contaminated does not equal septic
By far the most common source
Multiple related issues: drug therapy, foreign bodies, recent surgery

4. Intestinal R/A

5. Dehiscence

6. Common Causes Gastrointestinal tract Penetrating wounds
Migrating foreign bodies
Hepatic abscess
Pancreatic abscess
Genitourinary tract
Dog bite wounds do not have to cause an open wound to rupture the bowel
Recent lab with a SQ abscess
Don’t let the sun set on a closed pyo.

7. Goals Eliminate the source Repair damage Reduce bacterial load
Consider nutritional support
To drain or not to drain

8. Still closed?

9. Surgical Approach
Ventral midline celiotomy
Directly over wounds

10. Surgical Techniques Halsted’s principles Gentle tissue handling
Adequate hemostasis
Preservation of blood supply
Strict asepsis
No tension
Close approximation of tissues
Obliteration of dead space
*Don’t leave extra stuff behind

11. Surgical Techniques
Systematic evaluation of all intra-abdominal structures
The source is usually at the site of the most adhesions
Lavage
Drain(s) vs. open peritoneal drainage
+/- Feeding tube

12. Drains
Jackson-Pratt
Sump
Penrose

13. Jackson-Pratt Abdominal Drain
Multiple fenestrations
7-10 mm

14. Jackson-Pratt Abdominal Drain

15. Jackson-Pratt Abdominal Drain
Multiple fenestrations
7-10 mm
100 or 400 ml reservoir

16. Jackson-Pratt Abdominal Drain
Multiple fenestrations
7-10 mm
100 or 400 ml reservoir
Do not require 2nd surgery

17. Drains Jackson-Pratt Sump (double lumen, air in & fluid out) Penrose
Commercially available vs. Homemade

18. Open Peritoneal Drainage
Requires more intensive care
Risk of ascending bacterial infection
Requires second anesthetic/surgical episode
Loose simple continuous pattern in the linea
Tie-on bandage
Thick sterile absorptive layer followed by a non-permeable layer
Bandages changes potentially several times a day with “sterile technique”

19. Post-op
Intensive care
Intensive treatment
Intensive monitoring