Management of abdominal sepsis |
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Authors: | D Berger K Buttenschoen |
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Affiliation: | Department of General Surgery, University of Ulm, Steinh?velstrasse 9, D-89075 Ulm, Germany, DE
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Abstract: | Introduction: Today the management of the different forms of peritonitis is generally standardised. The classification of primary and secondary
peritonitis is well accepted. From a pathophysiological point of view, postoperative and post-traumatic peritonitis should
be considered as independent entities. The bacteriological isolates from the inflamed peritoneal cavity do not correlate with
the clinical course, and the occurrence of enterococci and bacteroides may be slightly related to ongoing infectious complications.
Classification: Valuable scoring systems mainly rely on systemic signs of the septic disease and seem to better differentiate the prognosis
of the disease than more surgically oriented scores do. Although the scoring systems did not allow any clinical decision,
they should be used to help better compare patients treated in different institutions. The observation of the minor relevance
of bacteriology and the superiority of general sepsis scores agrees with the fact that pre-existing septic organ dysfunction
and pre-existing comorbidity are the main determinants of mortality. Treatment: Surgical therapy focuses on the control of the source of infection because it has been clearly shown that, without resolving
the source of infection, the prognosis remains poor. Adjuvant surgical measures aim at the further reduction of the bacterial
load in the peritoneal cavity. Planned relaparotomy, relaparotomy on demand, and continuous closed peritoneal lavage are used.
Results: Clinical results proved these methods to be equally effective although pathophysiological considerations favour closed peritoneal
lavage. Conclusion: Summarising the available data, we need a more sophisticated understanding of the pathophysiology of the peritonitis, and
well-designed clinical studies are necessary to define the optimal surgical treatment modalities.
Received: 27 November 1997 |
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Keywords: | Abdominal sepsis Peritonitis Endotoxin Microbiology Pathophysiology Continuos peritoneal lavage Planned relaparotomy Interventional drainage |
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