MANAGEMENT OF POSTOPERATIVE PERITONITIS IN LOW-RESOURCES SERVICES

Mykola Droniak

Abstract


Background. Postoperative peritonitis (PP) reminds one of the most difficult complications in abdominal surgery with mortality rate 22.3 – 90 %.

Methods. In Ivano-Frankivsk Regional (tertiary level) Clinical Hospital (Ivano-Frankivsk, Ukraine) during 2010–2017 were operated 8762 patients with acute and chronic diseases of digestive system (appendicitis, pancreatitis, cholecystitis, bowel obstruction, complicated ulcer of upper gastrointestinal truck, mesenteric vessels thrombosis, abdominal adhesion diseases, hernia, Chron’s diseases, abdominal trauma), among them in 209 (2.4 %) patients developed PP. Local PP (abscess of abdominal cavity) had 142 (67.9 %), diffuse PP – 67 (42.1 %) patients.

Results. Clear local symptoms of peritonitis were absent in 178 (85.1 %) of 209 patients. General complication, such as acute respiratory failure had 95 (45.5 %), cardiovascular insufficiency – 68 (32.5 %), hepato-renal dysfunction - 46 (22 %) patients with PP. 129 (61.7 %) patients were treated by minimally invasive approach: 24 patients had laparoscopic lavage with drain of abdominal cavity abscess and 105 - ultrasound guided drain of abscess with catheter. 80 (38.3 %) patients had re-laparotomy (RL): 61 (91 %) from 67 with diffuse PP, 19 (13.4 %) from 142 patients – with local PP. 46 (57.5 %) patients underwent one RL, 26 (32.5 %) – two, 8 (10 %) patients – three RL. With increasing numbers of RL, increase mortality rate: after first RL died 7 (15.2 %) of 46 patients, after second RL – 12 (63.2 %) of 19, after third RL 6 (75 %) of 8 patients.

Conclusions. Together with standard surgical methods and precise technique were used lavage of abdominal cavity with 8 – 12 litres of antiseptic solutions, solution for peritoneal dialysis intraabdominally, nasointestinal drain tube, what was favourable for faster treatment of abdominal sepsis, reducing number of RL and postoperative mortality.


Keywords


postoperative peritonitis; relaparotomy; abdominal sepsis

Full Text:

PDF

References


Malangoni, M. A., Inui, T. (2006). Peritonitis – the Western experience. World Journal of Emergency Surgery, 1 (1), 25. doi: http://doi.org/10.1186/1749-7922-1-25

Sartelli, M., Griffiths, E. A., Nestori, M. (2015). The challenge of post-operative peritonitis after gastrointestinal surgery. Updates in Surgery, 67 (4), 373–381. doi: http://doi.org/10.1007/s13304-015-0324-1

Simmen, H. P., Heinzelmann, M., Largiadèr, F. (1996). Peritonitis: Classification and Causes. Digestive Surgery, 13 (4-5), 381–383. doi: http://doi.org/10.1159/000172468

Mulari, K., Leppäniemi, A. (2004). Severe Secondary Peritonitis following Gastrointestinal Tract Perforation. Scandinavian Journal of Surgery, 93 (3), 204–208. doi: http://doi.org/10.1177/145749690409300306

Bader, F., Schröder, M., Kujath, P., Muhl, E., Bruch, H.-P., Eckmann, C. (2009). Diffuse postoperative peritonitis – value of diagnostic parameters and impact of early indication for relaparotomy. European Journal of Medical Research, 14 (11), 491–496. doi: http://doi.org/10.1186/2047-783x-14-11-491

Winter, V., Czeslick, E., Sablotzki, A. (2007). Sepsis and multiple organ dysfunctions: pathophysiology and the topical concepts of treatment. Anesthesiology and Reanimatology, 5, 66–72.

Moore, L. J., Moore, F. A. (2012). Epidemiology of Sepsis in Surgical Patients. Surgical Clinics of North America, 92 (6), 1425–1443. doi: http://doi.org/10.1016/j.suc.2012.08.009

Weiss, G., Meyer, F., Lippert, H. (2006). Infectiological diagnostic problems in tertiary peritonitis. Langenbeck’s Archives of Surgery, 391 (5), 473–482. doi: http://doi.org/10.1007/s00423-006-0071-3

Evans, H. L., Raymond, D. P., Pelletier, S. J., Crabtree, T. D., Pruett, T. L., Sawyer, R. G. (2001). Diagnosis of intra-abdominal infection in the critically ill patient. Current Opinion in Critical Care, 7 (2), 117–121. doi: http://doi.org/10.1097/00075198-200104000-00010

Marshall, J. C., Cook, D. J., Christou, N. V., Bernard, G. R., Sprung, C. L., Sibbald, W. J. (1995). Multiple Organ Dysfunction Score. Critical Care Medicine, 23 (10), 1638–1652. doi: http://doi.org/10.1097/00003246-199510000-00007

Sartelli, M., Abu-Zidan, F. M., Catena, F., Griffiths, E. A., Di Saverio, S., Coimbra, R. et. al. (2015). Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study). World Journal of Emergency Surgery, 10 (1). doi: http://doi.org/10.1186/s13017-015-0055-0

Sartelli, M., Chichom-Mefire, A., Labricciosa, F. M., Hardcastle, T., Abu-Zidan, F. M., Adesunkanmi, A. K. et. al. (2017). The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World Journal of Emergency Surgery, 12 (1). doi: http://doi.org/10.1186/s13017-017-0141-6

ECDC. Annual epidemiological report. Antimicrobial resistance and healthcare associated infections (2014). http://ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-annual-epidemiological-report.pdf Last accessed: 10.05.2017

Theisen, J., Bartels, H., Weiss, W., Berger, H., Stein, H., Siewert, J. (2005). Current concepts of percutaneous abscess drainage in postoperative retention. Journal of Gastrointestinal Surgery, 9 (2), 280–283. doi: http://doi.org/10.1016/j.gassur.2004.04.008

Khurrum Baig, M., Hua Zhao, R., Batista, O., Uriburu, J. P., Singh, J. J., Weiss, E. G. et. al. (2002). Percutaneous postoperative intra-abdominal abscess drainage after elective colorectal surgery. Techniques in Coloproctology, 6 (3), 159–164. doi: http://doi.org/10.1007/s101510200036

Benoist, S., Panis, Y., Pannegeon, V., Soyer, P., Watrin, T., Boudiaf, M., Valleur, P. (2002). Can failure of percutaneous drainage of postoperative abdominal abscesses be predicted? The American Journal of Surgery, 184 (2), 148–153. doi: http://doi.org/10.1016/s0002-9610(02)00912-1

Burke, L. M. B., Bashir, M. R., Gardner, C. S., Parsee, A. A., Marin, D., Vermess, D. et. al. (2014). Image-guided percutaneous drainage vs. surgical repair of gastrointestinal anastomotic leaks: is there a difference in hospital course or hospitalization cost? Abdominal Imaging, 40 (5), 1279–1284. doi: http://doi.org/10.1007/s00261-014-0265-z

Sangrasi, A. K., Talpur, K. A. H., Kella, N., Laghari, A. A., Abbasi, M. R., Qureshi, J. N. (2013). Role of laparoscopy in peritonitis. Pakistan Journal of Medical Sciences, 29 (4), 1028–1032. doi: http://doi.org/10.12669/pjms.294.3624

Dellinger, R. P. (2003). Cardiovascular management of septic shock. Critical Care Medicine, 31 (3), 946–955. doi: http://doi.org/10.1097/01.ccm.0000057403.73299.a6

Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B. et. al. (2001). Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. New England Journal of Medicine, 345 (19), 1368–1377. doi: http://doi.org/10.1056/nejmoa010307

Ronco, C., D’Intini, V., Bellomo, R. et. al. (2005). Rationale for the use of extracorporeal treatments for sepsis. Anesthesiology and Reanimatology, 5, 87–91.

Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R. et. al. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Medicine, 43 (3), 304–377. doi: http://doi.org/10.1007/s00134-017-4683-6




DOI: http://dx.doi.org/10.21303/2504-5679.2019.00911

Refbacks

  • There are currently no refbacks.




Copyright (c) 2019 Mykola Droniak

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2504-5679 (Online), ISSN 2504-5660 (Print)