[Prevention of post-appendectomy infections].
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Analysis of 106 case-reports of patients developing complications after appendicectomy provided data on factors predisposing to these sequelae (general condition, initial appendicitis) and their severity (26 deaths equivalent to 24,5 p. cent). Complications were exclusively medical in 22 patients (12 deaths), or surgical in 48 cases (no deaths), and were multiple and/or mixed surgical sequelae in 36 patients (14 deaths). The severity of these medical and surgical complications is emphasized and their appropriate treatment proposed. Statistical analysis of findings in patients with several complications enabled definition of risk factors: peritonitis, septic shock, renal or respiratory insufficiency, age over 50 years, and previous history of disease. Analysis of these risk factors, whether multiple or associated with other complications, can be used for numerical rating of prognosis in these patients.
Postappendectomy fecal fistula formation in a young patient should suggest the possibility of Crohn's disease. The diagnosis can often be established by injection of water-soluble contrast into the fistula.
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A prospective clinical trial is carried out in 88 patients undergoing surgery for removal of the appendix. Authors show the efficacy of the association of pre and postoperative gentamycin plus clindamycin or lincomycin in prevention of postoperative infections, which, in the cases with non-ruptured appendix was 0%, and in gangrenous or perforated cases was 8.6%, with a global infection rate of 6% in this prophylactic subgroup I. However, when the same antibiotics are administered only postoperatively (subgroup II), global infection rate is of 34.2% similar to data in the literature in which no antibiotics were given. There have been no complications derived from this antibiotic prophylaxis.
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