Secondary peritonitis surgery
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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
Surgery is the mainstay of treatment for patients with secondary peritonitis.The choice depends on the focus of origin of infection. Prompt surgical intervention aims to eliminate the source of contamination, reduce the microbial pathogen and prevent the development of persistent sepsis.[1]Surgery (laparotomy) is needed to perform a full exploration and lavage of the peritoneum, as well as to correct any gross anatomical damage which may have caused peritonitis.[2] The exception is spontaneous bacterial peritonitis, which does not benefit from surgery. Nonoperative interventions for accessible abscess include: percutaneous drainage, which minimizes the risk of surgery.
Surgery
The type of surgical management depends on the site of infectious focus. Prevention of severe sepsis from secondary peritonitis can be achieved by drainage of all fluid collections, closure or resection of any gastrointestinal tract openings and prompt resection of inflamed and necrotic tissue.[1] The following table indicates the type of laparotomy needed depending on the origin of infection.[3][4]
| Site of infectious focus | Surgical management |
|---|---|
| Stomach | Resection or excision/ suture |
| Duodenum | Excision/ suture or resection |
| Small bowel | Resection with primary anastomosis or enterostomy or suture |
| Large bowel | Resection with Hartmann procedure or primary anastomosis |
| Appendix | Appendectomy |
| Gall bladder | Cholecystectomy |
| Biliary tree | Drainage and/or resection |
References
- ↑ 1.0 1.1 Bosscha K, van Vroonhoven TJ, van der Werken C (1999). "Surgical management of severe secondary peritonitis". Br J Surg. 86 (11): 1371–7. doi:10.1046/j.1365-2168.1999.01258.x. PMID 10583280.
- ↑ "Peritonitis: Emergencies: Merck Manual Home Edition". Retrieved 2007-11-25.
- ↑ Tellado J, Woods GL, Gesser R, McCarroll K, Teppler H (2002). "Ertapenem versus piperacillin-tazobactam for treatment of mixed anaerobic complicated intra-abdominal, complicated skin and skin structure, and acute pelvic infections". Surg Infect (Larchmt). 3 (4): 303–14. doi:10.1089/109629602762539535. PMID 12697078.
- ↑ Schein M, Marshall J (2004). "Source control for surgical infections". World J Surg. 28 (7): 638–45. doi:10.1007/s00268-004-7505-2. PMID 15185005.