Acute abdomen in the medical intensive care unit

Ognjen Gajic, Luis E. Urrutia, Hassanali Sewani, Darrell R. Schroeder, Daniel C. Cullinane, Steve G. Peters

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

Objective: Acute abdominal complication in the medical intensive care unit may be underdiagnosed and can add significant risk of death. We hypothesize that delays in surgery because of atypical presentation, such as the absence of peritoneal signs, may contribute to mortality. Design: Retrospective cohort study (1995-2000). Setting: Medical intensive care unit in a tertiary care center. Patients: Medical intensive care unit patients with clinical, surgical, or autopsy diagnosis of acute abdominal catastrophe (gangrenous or perforated viscus). Interventions: None. Measurements and Main Results: Seventy-seven patients (1.3%) met inclusion criteria. Ischemic bowel was the most common diagnosis, followed by perforated ulcer, bowel obstruction, and cholecystitis. Actual mortality rate was higher than predicted by Acute Physiology and Chronic Health Evaluation (APACHE) III scores at the time of medical intensive care unit admission (63% vs. 31%). Twenty-six patients (34%) did not have surgery, and none of these survived. Fifty-one patients underwent surgery and 28 survived (56%). Delay in surgical evaluation (p < .01) and intervention (p < .03), APACHE III scores (p < .01), renal insufficiency (p < .01), and a diagnosis of ischemic bowel (p < .01) were associated with increased mortality rates. Surgical delay was more likely to occur in patients with altered mental state (p < .01), no peritoneal signs (p < .01), previous opioids (p < .03), antibiotics (p < .02), and mechanical ventilation (p < .02). Conclusion: Delays in surgical evaluation and intervention are critical contributors to mortality rate in patients who develop acute abdominal complications in a medical intensive care unit.

Original languageEnglish (US)
Pages (from-to)1187-1190
Number of pages4
JournalCritical care medicine
Volume30
Issue number6
DOIs
StatePublished - Jan 1 2002

Keywords

  • Acute Physiology and Chronic Health Evaluation III
  • Complication
  • Critical care
  • Delay diagnosis
  • Ischemic bowel
  • Peptic ulcer
  • Perforated viscus
  • Peritonitis
  • Surgery

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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  • Cite this

    Gajic, O., Urrutia, L. E., Sewani, H., Schroeder, D. R., Cullinane, D. C., & Peters, S. G. (2002). Acute abdomen in the medical intensive care unit. Critical care medicine, 30(6), 1187-1190. https://doi.org/10.1097/00003246-200206000-00001