Postoperative sepsis: Reexplore or observe? Accurate indication from diagnostic abdominal paracentesis

Objective: To determine if postoperative diagnostic abdominal paracentesis is a useful clinical tool in the abdominal evaluation of the critically ill septic patient. Design: Retrospective review. Setting: Surgical ICU patients in a Veterans Administration medical center. Patients: Ten patients were studied from a total of 1,053 patients admitted to the surgical ICU between September 1985 and May 1989. Interventions: Diagnostic abdominal paracentesis performed by the open or closed approaches. Measurements and Main Results: Results are presented in three patient groups (A, B, and C): Group A (n = 4) had positive diagnostic abdominal paracentesis. Abdominal causes for the sepsis were found at reexploration. One of these four patients survived. Group B (n = 3) had negative diagnostic abdominal paracentesis. No abdominal septic source was found at reexploration; all three patients died. In group C (n = 3), diagnostic abdominal paracentesis was negative, patients were not reexplored, and all survived. Diagnostic accuracy correlated with three variables: a) the gross appearance and smell of the fluid, b) WBC count >5000 or <500/mm³, and c) Gram stain demonstrating bacterial organisms. Conclusions: Diagnostic abdominal paracentesis proved accurate, reliable, simple, safe, and rapid in evaluating the abdomen in the postoperative septic patient. The use of this procedure should be considered in postoperative septic patients in whom an abdominal source for the sepsis needs to be excluded.