Secondary peritonitis natural history
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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
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]
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.
- Critically ill patients receiving prolonged antibiotics are at an increased risk of developing opportunistic infections such as Clostridium difficile colitis, fungal infections, central venous catheter infections, and ventilator-associated pneumonia.
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.