Secondary peritonitis classification
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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
Classification
Classification Based on Etiology
| Secondary peritonitis[1] | |||||||||||||||||||||||||||||||||||||||
| Acute perforation peritonitis ❑ Gastrointestinal perforation ❑ Intestinal ischemia ❑ Pelviperitonitis and other forms | Postoperative peritonitis ❑ Anastomotic leak ❑ Accidental perforation and devascularization | Post-traumatic peritonitis ❑ After blunt abdominal trauma ❑ After penetrating abdominal trauma | |||||||||||||||||||||||||||||||||||||
Classification based on the extent of inflammatory process
- Acute secondary generalized peritonitis: Diffuse secondary peritonitis was defined as intraoperative evidence of inflammation of the peritoneal surface and/or contaminants/infectious peritoneal fluid in all quadrants of the abdomen due to an intestinal perforation.
- Acute secondary localized peritonitis:(peritoneal abscess)
Classification based on the source of infection
- Community acquired: Seen in about 70% of all cases of secondary peritonitis. Signifies mixed infection. Its bacterial spectrum differs depending on the site of the perforation or leakage. following gastro-duodenal perforations bacterial counts are usually low (<103/ml) and aerobic/anaerobic mixed infections are rare. Perforations of the biliary system or jejunum usually produce intermediate bacterial counts (103 - 105) and a mixed aerobic/ anaerobic infection in 50% of cases. colon or ileum perforations produce high bacterial counts (>105) and almost always a mixed aerobic/anaerobic bacterial infection Most frequently involved bacteria are e. coli, bacteroides fragilis and other anaerobes and enterococci. Apart from surgical interventions aiming to repair the bacterial leakage, a calculated antibiotic therapy should always be initiated pre-operatively or intra-operatively.
- Postoperative: Observed in about 30% of all cases of secondary peritonitis.[2]
Postoperative peritonitis is a nosocomial secondary peritonitis defined as an infectious abdominal complication following surgical interventions (i.e. anastomotic insufficiency following anterior rectum resection). Postoperative infections compared to tertiary peritoneal infections always require a surgical approach. It differs from other secondary peritoneal infections in that it has, diagnostic and therapeutic difficulties as well as worse prognosis. The majority of patients are usually already covered by antibiotics when the diagnosis is made and the microbial causes of such peritonitis tend to be multiple drug-resistant (MdR) including vancomycin resistant enterococci (incl. vRE), Gram-negative organisms (Extended spectrum beta lactamase or Ampicillin or carbapenemase-producer), MRSA and candida species.[3]. In addition, postoperative peritonitis was defined as a direct (e.g. anastomotic leakage) or indirect (e.g. perforated gastric ulcer after hemicolectomy) complication of a previously performed abdominal surgery.
References
- ↑ Wittmann DH, Schein M, Condon RE (1996). "Management of secondary peritonitis". Ann Surg. 224 (1): 10–8. PMC 1235241. PMID 8678610.
- ↑ Bader, FG; 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. doi:10.1186/2047-783X-14-11-491. ISSN 2047-783X.
- ↑ Eckmann C, Dryden M, Montravers P, Kozlov R, Sganga G (2011). "Antimicrobial treatment of "complicated" intra-abdominal infections and the new IDSA guidelines ? a commentary and an alternative European approach according to clinical definitions". Eur J Med Res. 16 (3): 115–26. PMC 3352208. PMID 21486724.