M. Schein· J.C. Marshall (Eds.) Source Control Springer-Verlag Berlin Heidelberg GmbH M. Schein J.C. Marshall (Eds.) Source Control A Guide to the Management of Surgical Infections , Springer MOSHE SCHEIN Professor of Surgery Weill Medical College of Cornell University Department of Surgery Bronx Lebanon Hospital Center 1650 Selwyn Avenue 4th Floor, Suite 4F Bronx, NY 10457, USA (e-mail: [email protected]) lOHN C. MARSHALL Professor of Surgery Eaton North 9-234 Toronto General Hospital University Health Network 200 Elizabeth Street Toronto, Ontario M5G 2C4. Canada (e-mail: [email protected]) ISBN 978-3-540-00408-0 ISBN 978-3-642-55914-3 (eBook) DOI 10.1007/978-3-642-55914-3 Library of Congress Cataloging-in-Publication Data Source control : A Guide to the management of surgical infections / M. Schein, J.C. Marshall (eds.). p.cm. Inc1udes bibliographical references and indeL I. Surgical wound infections--Treatment. I. Schein, Moshe.lI. MarshalI, J. (John), 1949- RD98.3 .S67 2002 6Ii.OI--dc21 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other way, and storage in data banks. Duplication of this pubkication or parts thereof is permitted only under the provision of the German Copyright Law of September 9,1965, in it's current version, and permission for use must aIways be obtained from Springer-Verlag. Violations are liable for prosecution under the German copyright Law. http://www.springer.de ~ Springer-Verlag Berlin Heidelberg 2003 Originally published by Springer-Verlag Berlin Heidelberg New York in 2003 The use of general descriptive names, registerd names, trademarks, etc. in this publication does not imply, even in the absende of a spedific statement,that such names are exempt form the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuray of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: design and production, Heidelberg Typesetting: Goldener Schnitt, Sinzheim SPIN: 10769410 24/3130 5 4 3 2 1 0 -Printed on acid-free paper Preface Surgical infections are infections that develop in surgical patients. They may develop before the operation or occur postoperatively. In fact, many surgical infections arise in patients who have not undergone an operation or who do not need one. Using such a broad definition, surgical infections form an integral and signifi cant part of any general, thoracic, and vascular surgery practice. We believe that the best infectious disease specialist for the sur gical patient is the educated surgeon. The concept of source control encompasses all of those physical interventions - surgical and otherwise - that are used to treat in fection. Although source control is one of the most important aspects of the treatment of serious infection, it is a topic that in the past has received relatively little attention. Our goal, in this book, is to correct this deficiency. This project grew out of an in itiative of the Source Control Working Group of the Surgical In fection Society (SIS) and almost all contributors are members of SIS or SIS-Europe. Each of the individual chapters - which cover general aspects of source control, as well as source control for specific conditions and anatomical sites - is followed by a balancing invited commentary by another expert. A certain amount of overlap is inevitable in such a multi-authored book; however, the many opinions expressed here reflect the dimensions of consensus and controversy in the field. This book is aimed principally at the practicing surgeon and surgical trainee, but will also be useful to the non-surgeon who takes part in the care of infected surgical patients in the intensive care environment, as well as to the infectious disease specialist. The most potent antibiotics, and the best supportive care, are meaningless if principles ofs ource control are not adhered to with obsessiveness. Moshe Schein, Bronx, New York October 2002 John C. Marshall, Toronto, Ontario Dedication This book had its genesis in a project initiated by the Surgical In fection Society to develop greater structure for the description and evaluation of the surgical management of infection. We are deeply grateful to the membership of the Surgical Infection Societies of North America and Europe, who not only supported this ambitious project, but also provided their experience and in sights as authors. We are immeasurably indebted to our families - the Schein family, my wife Heidi and sons Omri, Yariv, and Dan; and the Marshall clan, my wife and partner Mary Morison and our daughter Kate - for their love and tolerance of yet another in trusion into family life as the project took shape. We owe a huge vote of thanks to Mrs. Stephanie Benko from Springer-Verlag in Heidelberg, for shepherding the undertaking through to com pletion. And we dedicate our book to those who have experienced the ravages of infection, either themselves or through the tribu lations of a loved one, in the hope that it may contribute to im proving the care of future victims. Moshe Schein, New York May 2002 John C. Marshall, Toronto May 2002 Contents 1 Introduction JOHN C. MARSHALL, MOSHE SCHEIN •••••••.••••.•.•••••• Part I: Principles of Source Control 2 The Biological Rationale DAVID L. DUNN. • • • . • • . • • • • • . • • . • . • • . . • • • • • . • . • • • . • . 9 Invited Commentary RONALD V. MAIER. • . • . . • • • • • • • • • • • • . • • • . • . • . • • • • • • •• 13 Editorial Comment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 15 3 Experimental Models of Source Control PING WANG, IRSHAD H. CHAUDRy...................... 17 Invited Commentary MALCOLM R. KELL, H. PAUL REDMOND • • • • • • • . • • • . • • • • •• 22 Editorial Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 23 4 Drainage GyU I. GANG, JONATHAN F. MOULTON, JOSEPH S. SOLOMKIN •• 25 Invited Commentary ROBERT E. CONDON................................. 31 Editorial Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 33 5 Debridement and "Peritoneal Toilet" JOHN BOHNEN...................................... 36 Invited Commentary HIRAM C. POLK JR., DAVID A. SPAIN. • • • • . • • • • • • • • • • • • • •• 43 Editorial Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 45 6 Device Removal VICTOR LAZARON, GREGORY J. BEILMAN. • . • . • • • • • • • • • • . •• 47 Invited Commentary LORI L. BURROWS. • • . • • . • • • • • • •• • . • • . • • • • • • . • • • . • • •• 51 x Contents 7 Definitive Versus Temporizing Therapy DONALD E. FRY. • • • • • • • • • . • • • • • • • • . • . • • • • • • • • • • • • • •• 54 Invited Commentary EDWIN A. DEITCH. . • • • • • • • • • • • • • • • • • • • • • . • • • • • • • • • •• 59 Editorial Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 60 8 Deciding on the Extent of Surgical Therapy GIUSEPPE PAPIA, JOHN C. MARSHALL. • • • • • • • • • • • • • • • • • .• 62 Invited Commentary RHONDA S. FISHEL, ADRIAN BARBUL. • • • • • • • • • • • • • • • • • • •• 67 9 Consequences of Failed Source Control PHILIP S. BARIE, SOUMITRA R. EACHEMPATI • • • • • • • • • • • • • •• 71 Invited Commentary ARTHUR E. BAUE. • • • • • • • • • • • • • • • • • • • • • . • • . • • . • • . • • •. 81 Editorial Comment ............................... , 83 Part II: Source Control in Specific Locations 10 Diffuse Peritonitis BEAT GLOOR, MATHIAS WORNI, MARKUS W. BOCHLER •••••• 87 Invited Commentary WILLIAM G. CHEADLE •••••••••••••••.••••••••••••••• , 91 Editorial Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 92 11 Gastric and Proximal Small Bowel DAREN DANIELSON, MICHAEL A. WEST. • • • • • • • • • • • • • • • • •• 93 Invited Commentary DAVID LEAPER •••.•••••••••••••••••••••••••••••••••• 100 Editorial Comment ............................... , 101 12. The Colon DIETMAR H. WITTMANN •••••••••••••••.•••••••••••••• 103 Invited Commentary LEWIS FLINT • • • • • • • • • • • • • • • • • • • . • • • • • • • • • • • • • • • • • •• 109 Editorial Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. III 13 Infection and Trauma of the Rectum and Anus PER-OLOF NYSTROM •••••••••••••••.••••••••••••••••• 114 Invited Commentary LUIS A. CARRIQUIRY ................................. 121 Contents XI 14 Acute Appendicitis JAMES M. WATTERS ••••.••••••••••••••••••••••••••••• 124 Invited Commentary ROLAND E.B. ANDERSSON ••••••••••••••••••••••••••••• 130 Editorial Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 133 15 Bariatric Operations ROBERT E. BROLIN. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• 134 Invited Commentary NICOLAS V. CHRISTOU •••••••••••••••••••••••••••••••• 139 Editorial Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 140 16 The Gallbladder and Biliary Tree PETER GOTZINGER, REINHOLD FOGGER. • • • • • • • • • • • • • • • • •• 142 Invited Commentary JACK PICKLEMAN • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• 149 Editorial Comment ................................ 150 17 Pancreatic Infection PATCHEN DELLINGER .•••••••••••••••••••••••••••••••• 154 Invited Commentary BEAT GLOOR, MARKUS W. BOCHLER ••••••••••••••••••••• 162 Editorial Comment ................................ 165 18 Liver Abscesses ISKENDER SAYEK, DEMIRALI DNAT •••••••••••••••••.••••• 167 Invited Commentary ABE FINGERHUT •••• • • • • • • • • • • • • • • • • • • • • • • • • . • • • • • •• 175 Editorial Comment . .. . . .. .. . .. . .. .. . .. . .. . . .. . .. .. 177 19 Acute Mesenteric Ischemia DANIEL P. RAYMOND, ADDISON K. MAY •••••••••••••••••• 178 Invited Commentary ASHER HIRSHBERG •••••••••••••••••••••••••••••••••• 186 Editorial Comment ................................ 189 20 The Esophagus JAIME ESCALLON, MARIA FERNANDA JIMENEZ •••••••••.••.• 191 Invited Commentary J. DAVID RICHARDSON ••••••••••••••••••••••.••••••••• 197 Editorial Comment ................................ 200