Secondary peritonitis overview: Difference between revisions
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===Medical Therapy=== | ===Medical Therapy=== | ||
===Surgery=== | ===Surgery=== | ||
The surgical treatment of postoperative peritonitis is primarily aimed at defining source control, followed by debridement of fibrin bedding and abdominal lavage of contaminants and infectious fluids. In cases of suspected diffuse secondary peritonitis, indication for relaparotomy after positive findings in CT-scan were based on the following citeria: Evidence of leakage, intraabdomnal air after more than five days postoperatively, and/or massive collection of intraabdominal fluid. | The surgical treatment of postoperative peritonitis is primarily aimed at defining source control, followed by debridement of fibrin bedding and abdominal lavage of contaminants and infectious fluids. In cases of suspected diffuse secondary peritonitis, indication for relaparotomy after positive findings in CT-scan were based on the following citeria: Evidence of leakage, intraabdomnal air after more than five days postoperatively, and/or massive collection of intraabdominal fluid. Re-laparotomy has to be performed immediately following positive radiological examination and/or clinical/laboratory signs. In postoperative peritonitis, negative radiological findings and persistent symptoms of sepsis for longer than 24 hours were also indications for relaparotomy. | ||
===Prevention=== | ===Prevention=== | ||
Revision as of 20:00, 12 February 2017
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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]
Synonyms and keywords:: Surgical peritonitis, Perforation peritonitis, Acute peritonitis, Acute abdomen, Acute bacterial peritonitis, Acute generalized peritonitis, Abscess of suppurative peritonitis, Purulent peritonitis, Aseptic peritonitis, Chemical peritonitis, Peritoneal abscess.
Overview
Secondary peritonitis is the most common cause of peritonitis, seen in 80-90% of patients, as a result of inflammation, perforation, or gangrene of an intra-abdominal or retroperitoneal organs. Surgical intervention is typically required to treat these processes. Antibiotics play an adjunctive role in severe intra-abdominal infection. If left untreated, patients with secondary peritonitis usually die due to life-threatening sepsis and shock.
Definition
Secondary peritonitis is defined as the infection of the peritoneum due to spillage of organisms into the peritoneal cavity resulting from hollow viscus perforation, anastomotic leak, ischemic necrosis, or other injuries of the gastrointestinal tract.[1]
Historical perspective
- Mikulicz 1889; Krönlein 1885; Körte 1892 reported the surgical treatment of peritonitis.
- Kirschner in 1926 was the first to demonstrate a reduction in mortality rate by surgical treatment from 80–100% to about 60% in 1926.
Classification
Secondary peritonitis is classified based on the etiology and extension of inflammation.
Pathophysiology
Disturbances in the intestinal mucosal barrier as a result of spontaneous disease, trauma, or surgical operations permit escape of indigenous bacteria causing infection of the peritoneum.
Causes
Differentiating Secondary peritonitis from other conditions
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
The prognosis and outcome of patients with postoperative peritonitis is directly related to early diagnosis and stringent treatment interventions.
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT Scan
Ultrasound
Diagnostic Evaluation of Secondary Peritonitis
| Ascitic fluid with PMN ≥250 cells/mm3 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bile stained ascitic fluid | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ascitic fluid biluribin >6 mg/dl and ascitic fluid/serum bilurin >1 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| IF NO → | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| IF YES "BILIARY PERFORATION" | Fulfilment of atleast 2 of the following diagnostic criteria: ❑ Total protein >1g/dl ❑ Glucose <60 mg/dl ❑ LDH >upper limit of normal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| IF NO Ascitic PMN < baseline. After 48 hours of therapy with antibiotics | IF YES Free air or extravasation of contrast medium | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| IF YES "SPONTANEOUS BACTERIAL PERITONITIS" | IF NO | IF NO | IF YES "PERFORATION PERITONITIS" | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| "NON-PERFORATIONAL SECONDARY PERITONITIS" | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No evidence for loculated infection | Evidence for loculated infection with U/S or Barium enema etc. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| "SPONTANEOUS BACTERIAL PERITONITIS" ❑ Continue antibiotic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| LAPAROTOMY | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Medical Therapy
Surgery
The surgical treatment of postoperative peritonitis is primarily aimed at defining source control, followed by debridement of fibrin bedding and abdominal lavage of contaminants and infectious fluids. In cases of suspected diffuse secondary peritonitis, indication for relaparotomy after positive findings in CT-scan were based on the following citeria: Evidence of leakage, intraabdomnal air after more than five days postoperatively, and/or massive collection of intraabdominal fluid. Re-laparotomy has to be performed immediately following positive radiological examination and/or clinical/laboratory signs. In postoperative peritonitis, negative radiological findings and persistent symptoms of sepsis for longer than 24 hours were also indications for relaparotomy.
Prevention
References
- ↑ Calandra T, Cohen J, International Sepsis Forum Definition of Infection in the ICU Consensus Conference (2005) The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med 33 (7):1538-48. PMID: 16003060