What Gynecologists need to know about SIRS. (Systemic Inflammatory Response Syndrome).

ASHEVILLE, N.C. -- Systemic inflammatory response syndrome is not well known in the field of gynecologic surgery, despite being well described in the general surgery literature, Dr. William Saye said.

"It's definitely an entity that we need to know about," he said at the annual Southern Obstetric and Gynecologic Seminar.

Dr. Saye, a gynecologic surgeon in private practice in Marietta, Ga., said that gynecologists are most likely to encounter systemic inflammatory response syndrome (SIRS) in patients who have had an undetected bowel injury during laparoscopic surgery.

"SIRS is a response to inflammation, and there are a lot of different theories about its exact etiology. Basically, macrophages and white cells go to the site of the inflammation. This causes multiple micro-emboli in the area, decreasing the blood supply, and before you know it, the patient's white count drops and they go into acute respiratory distress syndrome," he said.

If not managed properly, acute respiratory distress syndrome can eventually lead to renal and liver failure.

SIRS most commonly occurs in the first 3 days following surgery and can be recognized by pain and a drop in the patient's white blood cell count, said Dr. Saye, who is also a consulting physician at Scott & White Hospital in Temple, Tex. What makes SIRS difficult to recognize is that it is very subtle: It does not produce high fevers and high white blood cell counts.

"The main thing is to do everything you can to recognize the injury at the time of surgery. But if you don't see an injury, then you have to be alert to the fact that you could have a subtle injury on someone you've operated on. If you've done a certain number of cases, you sort of know what to expect if someone starts calling you ...