Management of Postoperative Leukocytosis

Patient Assessment and Monitoring

The World Society of Emergency Surgery (WSES) recommends assessing for clinical signs of infection or sepsis, such as fever, tachycardia, hypotension, and altered mental status, in patients with leukocytosis after a Hartmann procedure 1, 2
Evaluating the surgical site for signs of wound infection and checking for abdominal tenderness, distention, or peritoneal signs that might indicate intra-abdominal infection is crucial 1
Blood cultures should be obtained if fever or other signs of systemic infection are present, and C-reactive protein (CRP) can be used as an additional inflammatory marker 2, 3

A CT scan of the abdomen/pelvis should be considered if there is concern for intra-abdominal abscess or anastomotic leak from the rectal stump 1, 2

The WSES guidelines recommend initiating broad-spectrum antibiotic therapy for intra-abdominal infections, and considering CT imaging to identify potential sources of infection 1, 4
For small abscesses (<3-6 cm), treatment with antibiotics alone may be sufficient, while larger abscesses (>3-6 cm) may require percutaneous drainage plus antibiotics 4, 5
In cases of sepsis or septic shock, immediate resuscitation and urgent source control are necessary, along with broad-spectrum antibiotics according to local antibiogram and patient risk factors 1, 4, 6

Immunocompromised patients may have atypical presentations with less pronounced leukocytosis despite serious infections, and require particular attention 3, 7
Kidney transplant patients with leukocytosis after a Hartmann procedure are at higher risk for severe complications of diverticulitis and warrant close monitoring 3, 7