My friend is in the hospital fighting for her life. She went in for a routine hysterectomy and the doctor accidentally poked a hole in her colon. Feces were leaking into her insides for more than five days. They have determined that she has an infection in the lining of her lungs that they had mistaken for pneumonia. She is on a respirator. Can someone recover from this kind of infectious damage? Her organs have not shut down yet, and she is on all kinds of antibiotics. Can a healthy 43-year-old nonsmoker possibly come through this?

A.P.

This very unfortunate case illustrates the dangers of even seemingly straightforward surgery. Occasionally mistakes occur, even in the best of circumstances. The complication you describe is rather uncommon. Anytime surgery involves entering the abdomen, there is a small risk of injuring the bowel. The colon is full of stool, much of which is bacteria, both dead and living. When stool remains contained within the bowel, there is no infection. When the bacteria spread outside the bowel and into the peritoneal cavity, a serious infection known as peritonitis occurs. The infection can spread to other organs and into the bloodstream, causing widespread infectious complications and sepsis.

When sepsis occurs, the bacteria and the immune system cells that fight infection release chemical mediators that can lead to septic shock -- low blood pressure and organ damage related to infection. Bacterial toxins and chemical mediators can damage the lungs, resulting in a condition called acute respiratory distress syndrome (ARDS), where the patient requires a ventilator to breathe. This may be what happened to your friend. She also had empyema, an infection in the lining of the lungs. This serious infection can either spread from a bacterial pneumonia or develop when bacteria from the blood reach this location. Either way, it usually requires drainage of the infected area with a chest tube.

Can your friend survive? The simple answer is yes. If she does not have multiple organ system failure, a grim prognostic (predictive) sign, then she could recover with eradication of the infections and excellent supportive care. In addition to treating the empyema with drainage, surgery is necessary to eradicate the intra-abdominal and pelvic infection. The hole in the colon must be repaired and any dead tissue must be removed. Also, washing out the peritoneal cavity may help speed recovery. Antibiotics are also needed to treat the infection.

Supportive care includes the use of a ventilator to help the patient breathe and strong medications to get her through the septic shock. These drugs, which are similar to epinephrine (adrenaline), help restore blood pressure to normal levels and keep the organs alive. However, any patient in such a condition also faces the risk of new infections. Having a breathing tube down the throat can lead to pneumonia; lines in the veins can foster bloodstream infections; catheters in the bladder can result in urinary infections; and lying in bed can lead to bedsores, which can become infected.