Secondary peritonitis natural history: Difference between revisions
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==Natural History== | ==Natural History== | ||
Secondary peritonitis is the initial phase of infection after intestinal perforation which can progress to abscess, if left untreated. Severe abdominal infections are invariably progress to a high level of sepsis, endotoxin production and systemic inflammatory response syndrome (SIRS), which often results in multiple organ failure.<ref name="pmid15846719">{{cite journal| author=Wong PF, Gilliam AD, Kumar S, Shenfine J, O'Dair GN, Leaper DJ| title=Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults. | journal=Cochrane Database Syst Rev | year= 2005 | volume= | issue= 2 | pages= CD004539 | pmid=15846719 | doi=10.1002/14651858.CD004539.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15846719 }} </ref><ref name="pmid6211996">{{cite journal| author=Berne TV, Yellin AW, Appleman MD, Heseltine PN| title=Antibiotic management of surgically treated gangrenous or perforated appendicitis. Comparison of gentamicin and clindamycin versus cefamandole versus cefoperazone. | journal=Am J Surg | year= 1982 | volume= 144 | issue= 1 | pages= 8-13 | pmid=6211996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6211996 }} </ref> | Secondary peritonitis is the initial phase of infection after intestinal perforation which can progress to abscess, if left untreated. Severe abdominal infections are invariably progress to a high level of sepsis, endotoxin production and systemic inflammatory response syndrome (SIRS), which often results in multiple organ failure.<ref name="pmid15846719">{{cite journal| author=Wong PF, Gilliam AD, Kumar S, Shenfine J, O'Dair GN, Leaper DJ| title=Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults. | journal=Cochrane Database Syst Rev | year= 2005 | volume= | issue= 2 | pages= CD004539 | pmid=15846719 | doi=10.1002/14651858.CD004539.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15846719 }} </ref><ref name="pmid6211996">{{cite journal| author=Berne TV, Yellin AW, Appleman MD, Heseltine PN| title=Antibiotic management of surgically treated gangrenous or perforated appendicitis. Comparison of gentamicin and clindamycin versus cefamandole versus cefoperazone. | journal=Am J Surg | year= 1982 | volume= 144 | issue= 1 | pages= 8-13 | pmid=6211996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6211996 }} </ref>. If properly treated, typical cases of surgically correctable peritonitis (e.g. perforated peptic ulcer, appendicitis, and diverticulitis) have a mortality rate of about <10% in otherwise healthy patients, which rises to about 40% in the elderly, and/or in those with significant underlying illness, as well as in cases that present late (after 48h). If untreated, generalized peritonitis is almost always fatal. | ||
==Complications== | ==Complications== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]
Overview
Overview
With treatment, patients usually do well. Without treatment, the outcome is usually poor. However, in some cases, patients do poorly even with prompt and appropriate treatment.
Natural History
Secondary peritonitis is the initial phase of infection after intestinal perforation which can progress to abscess, if left untreated. Severe abdominal infections are invariably progress to a high level of sepsis, endotoxin production and systemic inflammatory response syndrome (SIRS), which often results in multiple organ failure.[1][2]. If properly treated, typical cases of surgically correctable peritonitis (e.g. perforated peptic ulcer, appendicitis, and diverticulitis) have a mortality rate of about <10% in otherwise healthy patients, which rises to about 40% in the elderly, and/or in those with significant underlying illness, as well as in cases that present late (after 48h). If untreated, generalized peritonitis is almost always fatal.
Complications
- Tertiary peritonitis usually follows operative attempts to treat secondary peritonitis and is almost always associated with a systemic inflammatory response. It is a persistent/recurrent infection with organisms of low virulence.
- Surgical site infection and delayed wound healing- Depends on the degree of contamination. Measures taken to prevent postoperative infections such as peri-operative, systemic antibiotics, and lavage of the wound would not help to prevent this complication. In such instances, the wound should be kept open, and treated with wet-to-dry dressing several times a day. It occurs in 5-15% of patients.
- Intra-abdominal abscess
- Intraperitoneal adhesions, leading to bowel obstruction
- Septic shock
Prognosis
Factors affecting prognosis are:
- Age
- Blood pressure
- Cause of infection
- Site of origin of peritonitis
- Number of organs involved in multi-organ-failure (MOF)
- Pre-operative organ failure
- Presence of metabolic acidosis
- Serum albumin
- New York Heart Association cardiac function status
- Malnutrition
- Malignoma
- Fecal peritonitis
- Immunosuppression
References
- ↑ Wong PF, Gilliam AD, Kumar S, Shenfine J, O'Dair GN, Leaper DJ (2005). "Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults". Cochrane Database Syst Rev (2): CD004539. doi:10.1002/14651858.CD004539.pub2. PMID 15846719.
- ↑ Berne TV, Yellin AW, Appleman MD, Heseltine PN (1982). "Antibiotic management of surgically treated gangrenous or perforated appendicitis. Comparison of gentamicin and clindamycin versus cefamandole versus cefoperazone". Am J Surg. 144 (1): 8–13. PMID 6211996.