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PubMed1994

[Intra-abdominal infections].

We present 3 patients with intraabdominal infections. The diagnostic difficulties are caused by the atypical presentation of many of these infections. Fever, deterioration of general condition and loss of appetite and weight are uncharacteristic signs that lead to a delay in correct diagnosis and the beginning of therapy. In the following paper we discuss septic pylephlebitis, spontaneous bacterial peritonitis and renal abscesses as important representatives of intraabdominal infections.

Abdomen, Acute↗

PubMed1998

Tertiary peritonitis: clinical features of a complex nosocomial infection.

The objective of this study was to define risk factors for and the clinical course of recurrent or tertiary peritonitis. Intensive supportive care of patients with life-threatening intraabdominal infections has led to the emergence of a new clinical syndrome, tertiary peritonitis, defined as the persistence or recurrence of intraabdominal infection following apparently adequate therapy of primary or secondary peritonitis. We undertook a retrospective study of 59 patients admitted with intraabdominal infection to a surgical intensive care unit (ICU). Tertiary peritonitis developed in 74% (44/59) of patients. Despite comparable premorbid health status, source of peritonitis, and admission APACHE II scores, patients with tertiary peritonitis had a significantly longer ICU stay (21.8 +/- 14.9 vs. 8.5 +/- 7.9 days), more advanced organ dysfunction reflected in higher organ dysfunction scores (13.3 +/- 5.1 vs. 7.7 +/- 3.3), and higher ICU mortality (64% vs. 33%) than patients with uncomplicated secondary peritonitis. The most common infecting organisms in patients with tertiary peritonitis were Enterococcus, Candida, Staphylococcus epidermidis, and Enterobacter. Infectious foci were rarely amenable to percutaneous drainage and were found to be poorly localized at laparotomy. Recurrent, or tertiary, peritonitis is a common complication of intraabdominal infection in patients admitted to an ICU. It differs from uncomplicated secondary peritonitis in its microbial flora and lack of response to appropriate surgical and antibiotic therapy. Like nosocomial pneumonia in the critically ill patient, the syndrome appears to be more a reflection than a cause of adverse outcome.

Adult↗

PubMedDate not supplied

Surgical prophylaxis and treatment of surgical infections with quinolones.

Intraabdominal infections occur after trauma, surgical resections, or development of intrinsic diseases of the gastrointestinal tract. These infections, which may be generalized or localized in intraperitoneal or extraperitoneal locations and in organs, are often difficult to diagnose and treat. The infections are usually polymicrobial and can involve both aerobic and anaerobic microorganisms. Adequate surgical drainage and antimicrobial therapy improve the clinical course and reduce the risk of septicemia and local complications. There are only a few studies published to date concerning the use of the new quinolones for surgical prophylaxis and treatment of surgical infections. On the basis of these studies, it can be concluded that surgical infections due to enterobacteria and staphylococci may be successfully treated with the new quinolones. When streptococci or anaerobic bacteria are involved, antimicrobial agents effective against these microorganisms must be added.

4-Quinolones↗

PubMed1999

The duration of antibiotic administration in penetrating abdominal trauma.

BACKGROUND: The epidemiology of penetrating abdominal trauma is changing to reflect an increasing incidence of multiple injuries. Not only do multiple injuries increase the risk of infection, a very high risk of serious infection is conferred by immunosuppression from hemorrhage and transfusion and the high likelihood of intestinal injury, especially to the colon. Optimal timing and choice of presumptive antibiotic therapy has been established for penetrating trauma, but duration has not been studied extensively in such seriously injured patients. The purpose of this study was to test the hypothesis that 24 hours of antibiotic therapy remains sufficient to reduce the incidence of infection in penetrating abdominal trauma. METHODS: Three hundred fourteen consecutive patients with penetrating abdominal trauma were prospectively randomized into two groups: Group I received 24 hours of intravenous cefoxitin (1 g q6h) and group II received 5 days of intravenous cefoxitin. The development of a deep surgical site (intra-abdominal) infection as well as any type of nosocomial infection, as defined by the Centers for Disease Control and Prevention, (ie, surgical site infections, catheter-related infections, urinary tract, pneumonia), was recorded. Hospital length of stay was a secondary endpoint. Statistical analysis included chi-square tests for coordinate variables and two-tailed unpaired t tests for continuous variables. The independence of risk factors for the development of infection was assessed by multivariate analysis of variance. Significance was determined when P <0.05. RESULTS: Three hundred patients were evaluable. There was no postoperative mortality, and no differences in overall length of hospitalization between groups. The duration of antibiotic treatment had no influence on the development of any infection (P = 0.136) or an intraabdominal infection (P = 0.336). Only colon injury was an independent predictor of the development of an intraabdominal infection (P = 0.0031). However, the overall infection incidence was affected by preoperative shock (P = 0.003), colon (P = 0.0004), central nervous system (CNS) injuries (P = 0.031), and the number of injured organs (P = 0.026). Several factors, including intraoperative shock (P = 0.021) and injuries to the colon (P = 0.0008), CNS (P = 0.0001), and chest (P = 0.0006), were independent contributors to prolongation of the hospital stay. CONCLUSIONS: Twenty-four hours of presumptive intravenous cefoxitin versus 5 days of therapy made no difference in the prevention of postoperative infection or length of hospitalization. Infection was associated with shock on admission to the emergency department, the number of intra-abdominal organs injured, colon injury specifically, and injury to the central nervous system. Intra-abdominal infection was predicted only by colon injury. Prolonged hospitalization was associated with intraoperative shock and injuries to the chest, colon, or central nervous system.

Abdominal Injuries↗

PubMed2003

Appendicitis in children: a ten-year update of therapeutic recommendations.

BACKGROUND/PURPOSE: In 1990, the authors reported excellent outcomes using a standard protocol to treat pediatric appendicitis. This protocol has been simplified further and a large retrospective review was conducted to assess current outcomes. METHODS: All patients treated for presumed appendicitis between April 1997 and December 1999 were reviewed. All patients received preoperative gentamicin and clindamycin. Patients with complicated appendicitis received postoperative ampicillin, gentamicin, and clindamycin or metronidazole. All wounds were closed primarily without drains. Patients with complicated appendicitis were discharged when their ileus resolved, they remained afebrile for 24 hours, and had a normal leukocyte count. RESULTS: A total of 648 patients were reviewed. A total of 9.4% of appendices were pathologically normal, 55.6% were simple acute, 15.7% were gangrenous, and 19.3% were perforated. Hospital stay was 2.21 +/- 2.04 days for normal, 1.39 +/-.89 for simple acute, 2.97 +/- 1.25 for gangrenous, and 6.31 +/- 3.51 days for perforated appendices. There were no wound infections in patients with normal or simple acute appendices. Two minor intraabdominal infections (0.56%) occurred in patients with simple appendicitis. Patients with complicated appendicitis (gangrenous or perforated) had wound infection and intraabdominal infection rates of 2.6% and 4.4%, respectively. CONCLUSIONS: The authors' current protocol results in reasonable hospital stays and good outcomes. It serves as an evidence-based standard of care for the treatment of pediatric appendicitis.

Abdominal Abscess↗

PubMed2002

Safety and efficacy of cefepime versus ceftazidime in the treatment of severe infections.

An open-label, randomized study was conducted to evaluate the safety and efficacy of cefepime versus ceftazidime in the treatment of severe bacterial infections, including septicemia, urinary tract infection, bacterial bronchitis, bacterial pneumonia, and intraabdominal infection. Fifty-two patients with severe infections were eligible and prospectively randomized to receive cefepime (26 patients) or ceftazidime (26 patients) during a 15-month period. Forty-two patients were evaluable (24 in the cefepime group and 18 in the ceftazidime group). Most (86%) of the patients had urinary tract infections and the most commonly isolated pathogen was Escherichia coli (79%). Satisfactory clinical response rates of 71% and 61%, and bacteriological eradication rates of 87.5% and 89% were achieved for the cefepime and ceftazidime groups, respectively. Two patients treated with cefepime died, one from superinfection and one from suspected paraneoplastic syndrome. Cultures of the blood obtained at entry into the study were positive in 19 (45%) of the 42 evaluable cases. In the cefepime group, a patient with Salmonella paratyphi A septicemia was cured, which has not been previously reported. Adverse effects attributable to therapy were minimal in both groups of patients, and none required discontinuation or dose reduction. In conclusion, these results suggest that cefepime is as efficacious and well tolerated as ceftazidime in the treatment of severe bacterial infections, such as septicemia, urinary tract infection, bacterial bronchitis, bacterial pneumonia, and intraabdominal infection.

Adolescent↗

PubMed2006

Intraabdominal tissue concentration of ertapenem.

OBJECTIVES: Ertapenem, a class I carbapenem, is approved for the treatment of mild to severe intraabdominal infections, but its in vivo concentrations in intraabdominal tissues are unknown. The purpose of this study was to determine the concentration of ertapenem in intraabdominal tissue. PATIENTS AND METHODS: After informed consent 48 patients, 23 female and 25 male with a median age of 58 years (34-81), requiring surgical intervention at intraabdominal organs were enrolled. Patients received 1 g of ertapenem intravenously for perioperative prophylaxis. Tissue samples were taken after resection of parts of the organs. Plasma samples were taken when tissue samples were taken. Drug concentrations were determined by liquid chromatography/mass spectrometry. An ANCOVA test (analysis of covariance) was performed to assess organ-specific differences in ertapenem concentration and penetration ratios. RESULTS: Mean+/-SD ertapenem tissue concentration (mg/kg) was 16.0+/-8.8 in the gall bladder, 12.1+/-5.3 in the colon, 7.0+/-5.7 in the small bowel, 4.5+/-2.3 in the liver and 3.4+/-2.9 in the pancreas. The mean tissue/plasma ratio was 0.19 (colon), 0.17 (small bowel), 0.17 (gall bladder), 0.088 (liver) and 0.095 (pancreas). The ANCOVA test revealed statistically significant organ-specific differences in ertapenem tissue concentration in the gall bladder versus liver/pancreas and in tissue penetration for the colon versus liver/pancreas. CONCLUSIONS: These pharmacokinetic results support the assumption that ertapenem is suitable for the treatment of intraabdominal infections.

Abdomen↗

PubMed2006

Infectiological diagnostic problems in tertiary peritonitis.

BACKGROUND: The tertiary peritonitis causes the highest mortality in intraabdominal infections. Surgical interventions and antibiotic therapy may only provide an incomplete impact on nosocomial infections acquired at an intensive care unit (ICU) [Nathens et al., World J Surg 22:158-163, 28]. To open up new resources in the management, in particular, in the previous infectious diagnostic, the aim was to investigate the infectious course as well as the diagnostic value of laboratory parameters and microbiological monitoring. MATERIALS AND METHODS: In this retrospective patient cohort study from the Surgical ICU of a University Hospital (capacity, n=12), overall, 60 patients with a tertiary peritonitis were enrolled. RESULTS: Approximately 20% of the patients with an intraabdominal infection developed a tertiary peritonitis. A tertiary peritonitis can more frequently develop in nosocomial intraabdominal infections, in particular, in case of necrotizing pancreatitis. The device-associated infection rate in the spectrum of nosocomial infections is sevenfold higher than in all ICU patients. Compared with the secondary peritonitis, its mortality is double as high: 35%. In the diagnostic characterizing the course of the nosocomial, prognosis-relevant infections, usual inflammatory parameters show a considerable loss of their sensitivity with a range from 35-57%. By the mean of a routine microbiological monitoring, 47.3% of the analysed subsequent infections could be identified at an early stage. CONCLUSION: In patients with a severe infection, an early diagnostic and treatment of infectious "second hits" can improve the complication rate and prognosis. During the prolonged and complicated septic course of tertiary peritonitis, an additional routine microbiological monitoring contributed effectively to early detection and diagnostic of nosocomial infections. Further studies to investigate the value and efficacy of such monitoring, which have been abandoned, should be undertaken in infectious high-risk patients.

Cross Infection↗

PubMed1999

Surgical complications after pancreas transplantation with portal-enteric drainage.

BACKGROUND: Despite recent advances, surgical complications remain an important source of morbidity after pancreas transplantation (PTX). Several previous studies have delineated the surgical complications after PTX with systemic-bladder (S-B) drainage, but data are limited regarding the incidence and outcomes of surgical complications after PTX with portal-enteric (P-E) drainage. STUDY DESIGN: We retrospectively studied surgical complications after 83 vascularized PTXs with P-E drainage in 79 patients (65 simultaneous kidney-PTXs [SKPT] and 18 solitary PTXs [SPT], 8 pancreas alone and 10 pancreas after kidney transplantation). Twelve (15%) were retransplants. A surgical complication was defined as the need for repeat laparotomy within the first 3 months after PTX. RESULTS: A total of 53 surgical complications requiring repeat laparotomy occurred in 31 patients (37%). The incidence of surgical complications in SKPT and SPT was 38% and 33%, respectively. The most common indications for repeat laparotomy were: vascular thrombosis in 13% (SKPT 14% and SPT 11%), intraabdominal infection in 10% (SKPT 12% and SPT 0%), intraabdominal bleeding in 8% (SKPT 8% and SPT 11%), and duodenal allograft leak in 4% (SKPT 3% and SPT 6%). Patient survival rates at 1 and 3 years with versus without surgical complications were 84% and 80% versus 94% and 86%, respectively (p = NS). Pancreas graft survival rates at 1 and 3 years with versus without surgical complications were 48% and 44% versus 89% and 76%, respectively (p < 0.0001). The incidence of surgical complications was 45% in the first 42 P-E transplantations performed between 1990 and 1995, compared with 29% in the next 41 transplantations performed during 1996 and 1997 (p = NS). The mean number of repeat laparotomies per patient decreased from 1.2 in the former group to 0.5 in the latter group (p = NS). The incidence rates of vascular thrombosis, intraabdominal infection, and duodenal leak in the former and latter groups were 17% versus 10%, 12% versus 7%, and 2% versus 5%, respectively. CONCLUSIONS: Surgical complications after PTX are common, and their incidence and outcomes with P-E drainage are similar to those with S-B drainage. The complication rate does not vary according to the type of transplant (SKPT versus SPT). Increasing experience with P-E drainage results in a decreased incidence of surgical complications.

Adult↗

PubMed1994

Detection of intraabdominal abscess by serum lysozyme estimation.

BACKGROUND: The failure of new, innovative, and often expensive tests to show the presence of intraabdominal infection caused us to reexamine the value of an inexpensive and almost forgotten one. Lysozyme is a bacteriolytic enzyme located within the lysosomes of phagocytic cells including leukocytes. METHODS: We measured serum concentrations of lysozyme by a standard turbidimetric method in both a murine model of intraabdominal infection and in trauma patients with intraabdominal abscesses or other acquired infections. RESULTS: In mice with intraabdominal abscess secondary to cecal ligation and puncture (n = 35) serum lysozyme activity increased compared with sham-operated controls (n = 20; p < 0.001). In trauma patients with intraabdominal abscess after injury and surgery (n = 19), there was also an increase in serum lysozyme activity compared with controls (n = 15; p < 0.001) or with patients with lung infection (n = 21; p < 0.001). The increase of serum lysozyme activity occurred before intraabdominal sepsis was clinically apparent. CONCLUSIONS: In this study, serum lysozyme concentration has a high specificity related to the presence of an intraabdominal abscess and is an indirect measure of the sequestration of leukocytes to the site of an established or developing collection of intraabdominal pus. The estimation of serum lysozyme may be an aid to differentiate critically ill patients with a potential occult intraabdominal abscess.

Abdomen↗

PubMed1994

Immune response in patients with intra-abdominal infections treated with carbapenems.

The immune responses against isolated microorganisms in patients with intraabdominal infections treated with meropenem or imipenem/cilastatin were investigated. Fifty-nine patients received meropenem 500 mg t.i.d. intravenously for 3-21 days (mean 5.4 days) and 50 patients imipenem/cilastatin 500 mg/500 mg t.i.d. intravenously for 3-17 days (mean 5.1 days). Three serum samples were taken from each patient, the first sample at admission, the second sample between three and seven days after start of antibiotic treatment, and the third sample between 14 and 28 days later. Ninety-eight per cent of the patients in the meropenem group and 95% of the patients in the imipenem/cilastatin group were cured. There was no difference in the clinical outcome between the two treatment groups. Escherichia coli, Bacteroides fragilis group, anaerobic cocci, Staphylococcus epidermidis, and Klebsiella spp. predominated among the isolated microorganisms. Thirty-nine patients in the meropenem group had significant immune responses against one or more of the isolated microorganisms while 31 patients in the imipenem/group had significant responses. E. coli and B. fragilis gave rise in antibody titres in most patients indicating that these species are the most important pathogens in intraabdominal infections.

Abdominal Abscess↗

PubMed1995

A Double-Blind, Randomized Comparison of Aztreonam Plus Clindamycin with Tobramycin Plus Clindamycin in Abdominal Infections.

Seventy patients with intraabdominal infections were randomly assigned in double-blinded fashion to receive either the combination of tobramycin plus clindamycin (TM/C) or aztreonam plus clindamycin (AZ/C). Thirty-four patients received AZ/C and 36 were given TM/C. Average ages were 62 years (TM/C) and 66 years (AZ/C). In approximately one-half of both groups, the source of infection was perforated colon or perforated appendix. There were no significant differences in demographic factors between these groups, although those given AZ/C had a more serious long-term prognosis due to underlying diseases. The average lengths of treatment were 10 days (TM/C) and 9 days (AZ/C). Clinical response to therapy did not differ, as 84% of the TM/C patients and 78% of the AZ/C patients had satisfactory clinical responses. The two regimens differed in adverse effects, as an elevated PT/PTT was more frequently (p < 0.05) observed in AZ/C. All PT/PTT elevations responded to injections of vitamin K, and no serious bleeding occurred. Choice between these regimens depends on differences in cost and the risk of adverse effects, as both regimens appear equally effective for treatment of abdominal infections in conjunction with appropriate surgical intervention.

Journal Article↗

PubMedDate not supplied

Frequency of occurrence and antimicrobial susceptibility of bacterial isolates from the intestinal and female genital tracts.

In the selection of empiric therapy for infections of the female genital tract and intraabdominal infections in humans, the requisite information includes (1) the frequency of isolation of bacterial species dominant in the normal gastrointestinal and female genital tracts and in intraabdominal and female genital tract infections and (2) the in vitro susceptibilities of the dominant species to drugs that may be used against them (e.g., penicillin G, cefoperazone, cefoxitin, chloramphenicol, clindamycin, and metronidazole). The predominant bacteria in fecal contents are not necessarily those most frequently found in infections. Intraabdominal and perirectal infections are usually polymicrobial, resulting from mixtures of facultative species (coliforms and streptococci) and anaerobes. The predominant bacteria of the normal vagina and cervix are lactobacilli, facultative streptococci, Peptococcus species, and Peptostreptococcus species. Most infections of the female genital tract are due to mixtures of facultative enteric bacilli, streptococci, and anaerobes (Peptococcus and Peptostreptococcus species, Bacteroides fragilis, Bacteroides disiens, Bacteroides melaninogenicus, Bacteroides bivius, and Bacteroides asaccharolyticus). Of the antibiotics tested, clindamycin appears the most active against many of the groups of bacteria isolated.

Abdomen↗

PubMed1984

Different antimicrobial agents in treatment and prophylaxis of experimentally induced intraabdominal sepsis.

A reproducible experimental model of intraabdominal infection in rats has been worked out in order to simulate intraabdominal sepsis seen in humans and to test different antimicrobial agents in treatment and prophylaxis of intraabdominal infections. This experimental model was used to evaluate the efficacy of benzylpenicillin, benzylpenicillin plus sulbactam, cefoxitin, thienamycin, clindamycin, tinidazole, netilmicin, clindamycin plus netilmicin, and tinidazole plus netilmicin in the treatment of intraabdominal sepsis. Sixty-five per cent of the untreated animals died within two days. Within four days, 43% of the animals receiving clindamycin alone, 22% receiving tinidazole alone and 46% receiving netilmicin alone died. Animals treated with piperacillin, clindamycin plus netilmicin or tinidazole plus netilmicin showed a significantly decreased mortality and increased cure rates during the experimental period. Sixty-five per cent of the untreated animals and the animals given sulbactam alone died within 48 h. Over 90% of the animals given benzylpenicillin died within five days. Animals treated with benzylpenicillin plus sulbactam, cefoxitin or thienamycin had a significantly decreased mortality. Within four days 22% of the animals receiving tinidazole alone, 43% receiving clindamycin alone and 46% receiving netilmicin alone died. Animals treated with tinidazole plus netilmicin or clindamycin plus netilmicin had a significantly decreased mortality and increased cure rates during the experimental period. Only 5% of these animals died. In the prophylaxis experiment the following agents were tested: cefoxitin, doxycycline, tinidazole plus netilmicin, clindamycin plus netilmicin, and trimethoprim-sulfa plus tinidazole. One dosage of the antimicrobial(s) reduced the mortality rate significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1996

Piperacillin/tazobactam: a critical review of the evolving clinical literature.

Piperacillin/tazobactam is the most recently approved combination of a beta-lactam agent with an inhibitor of bacterial beta-lactamases. It has a broader spectrum than do preceding inhibitor-drug combinations, and it is generally more potent. In terms of clinical and microbiological outcomes, comparative studies have shown that piperacillin/tazobactam was comparable to imipenem (1.0 g q8h) and to clindamycin plus gentamicin for intraabdominal infections, to clindamycin plus gentamicin for infections of the skin and skin structures and pelvic tissues in women, and to ticarcillin/clavulanate for skin and soft-tissue infections. Piperacillin/tazobactam was statistically superior to imipenem (0.5 g q8h) for intraabdominal infections, to ticarcillin/clavulanate for community-acquired lower respiratory tract infections, and to ceftazidime for nosocomial lower respiratory tract infections and febrile episodes in neutropenic patients. Adverse effects with piperacillin/tazobactam were generally of only mild-to-moderate severity. Piperacillin/tazobactam may be especially useful for the treatment of infections that are likely to be polymicrobial or to be due to any one of an array of aerobic or anaerobic bacteria; this agent may also be useful in situations where organisms with plasmid-mediated beta-lactamases have become problematic.

Drug Therapy, Combination↗

PubMed1987

Infected aortic aneurysm after intraabdominal abscess.

Infected abdominal aortic aneurysm is rarely associated with an antecedent history of a localized suppurative process. This report describes a case in which an infected aortic aneurysm occurred after surgical treatment of an appendiceal abscess. Diagnosis and management of infected aneurysms are discussed, together with a review of the literature.

Journal Article↗

PubMed2006

Omentum prevents intestinal adhesions to mesh graft in abdominal infections and serosal defects.

BACKGROUND: Many studies have evaluated the use of grafts in the reconstruction of abdominal wall defects. In this study, the effects resulting from the presence or absence of the omentum were evaluated in the setting of infection or serosal defects in the formation of adhesions in abdominal closures using mesh grafts. METHODS: For this study, 60 Wistar albino rats were divided into six groups. A circular 3.79-cm(2) fascioperitoneal defect was created. After group-specific procedures, defects were reconstructed using polypropylene mesh grafts. In group C (control group), only a mesh graft recontruction was performed, whereas group O (O for omentectomy) underwent an omentectomy plus mesh closure. In group SD (serosal defect group), the cecum was abrased with a brush before mesh closure. Group SDO underwent cecal abrasion plus an omentectomy. In group I (infection group), the intraabdominal space was filled with 1 ml of solution containing 100,000 colony-forming units (CFUs) of Escherichia coli per milliliter. Group IO received the same same amount of E. coli solution plus an omentectomy before mesh closure. After 28 days, the groups were evaluated by intraabdominal and blood cultures, grading of intraabdominal adhesions, graft-organ adhesions, proportion of adhesions to graft size, and histopathologic studies. The results were statistically evaluated using one-way variant analysis and Scheffe's and Fisher's definite chi-square tests. RESULTS: For the groups in which the greater omentum was preserved, intestinal adhesions to the graft surface were less frequently observed, especially in cases with intraabdominal infections and serosal defects (p < 0.05). CONCLUSIONS: Preservation of the greater omentum reduces the formation of intestinal adhesions, especially in cases with underlying infections and serosal defects in abdominal closures using mesh grafts. This could be beneficial in related clinical situations in lowering the rate of intestinal fistulas, erosions, and obstructions that can be attributed to the formation of adhesions.

Abdomen↗

PubMed1987

Effect of incidental appendectomy on the development of wound infection in patients undergoing staging laparotomy for Hodgkin's disease.

Two hundred ten patients were retrospectively studied to evaluate the risk of appendectomy performed during laparotomy for staging of Hodgkin's disease. Seventy-nine patients did not have their appendix removed, and a wound infection developed in 1. One hundred thirty-one patients had an appendectomy, and 7 wound infections occurred in this group. This difference was not statistically significant. No patient died as a consequence of their wound infection, and no intraabdominal infections occurred. Our data suggest that the risk for development of a wound infection after a staging laparotomy for Hodgkin's disease is increased by performing an incidental appendectomy as part of the procedure. Although the differences noted were not statistically significant, this was probably due to the sample size. Based on our data, we do not routinely remove the appendix at the time of staging laparotomy.

Adolescent↗