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Diffuse Peritonitis (diffuse + peritonitis)
Selected AbstractsPotential Prognostic Indicators in Diffuse Peritonitis Treated with Open Peritoneal Drainage in the Canine PatientJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2000DACVS, Kevin P. Winkler DVM Summary The purpose of this study was to identify prognostic indicators that may help to predict outcome in clinical cases of diffuse peritonitis treated with open peritoneal drainage. Medical records from 19 canine patients with generalized peritonitis treated with open peritoneal drainage between 1990 and 1996 were reviewed. The signalment, preoperative complete blood count (CBC), preoperative biochemical profiles, and number of days of open peritoneal drainage of surviving patients (n = 15) were compared to nonsurviving patients (n = 4). Significant differences were noted between the surviving and nonsurviving groups in the ALT (p = 0.02) and GGT (p = 0.01) values. Seventy-nine percent of the patients in this study survived. [source] Role of resection and primary anastomosis of the left colon in the presence of peritonitis,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2000Dr S. Biondo Background Classically a primary colonic anastomosis is not performed in the presence of left colonic peritonitis. Recently there has been a trend towards resection and anastomosis in selected patients, but no prospective study concerning the safety of this approach has been published. The objective of this study was to define the role of intraoperative colonic lavage with resection and primary anastomosis (RPA) in left colonic peritonitis, and to evaluate the differences in outcome in patients with diffuse or localized peritonitis. Methods Between January 1994 and December 1998, 127 patients underwent emergency operation for a distal large bowel perforation. RPA was the operation of choice and was performed in 61 patients, 38 with localized and 23 with diffuse peritonitis. Septic shock, faecal peritonitis, immunocompromised status and American society of Anesthesiologists grade IV were contraindications to the one-stage procedure. Alternative operations used in high-risk patients were Hartmann's procedure in 55 patients, subtotal colectomy in eight and colostomy in three. Results There were two deaths (3 per cent) among 61 patients treated by RPA and one (2 per cent) case of clinical anastomotic dehiscence. Overall morbidity was 39 per cent and the overall mean(s.d.) hospital stay was 18(15) days. No statistical differences were observed between patients with localized and diffuse peritonitis treated by RPA. Conclusion RPA may be the operation of choice in selected patients with left colonic diffuse peritonitis. © 2000 British Journal of Surgery Society Ltd [source] Utility of appropriate peritonitis grading in the surgical management of perforated sigmoid diverticulitisCOLORECTAL DISEASE, Issue 6 2000K. Thaler Objective We evaluated the prognostic validity of preoperative risk scores in the surgical management of patients with diverticular perforation and diffuse peritonitis. Patients and methods From 1988 to 1998, 82 patients, mean age 72 ± 15 years, underwent urgent surgery for perforated diverticulitis with generalized peritonitis. They were operated either with the Hartmann technique or with resection and primary anastomosis. ASA Classification and Mannheimer Peritonitis Index (MPI) were documented as risk scores at time of surgery and used as guidelines to decide for one of both procedures. Results A Hartmann resection (HA) was performed in 62 patients (76%) and resection with primary anastomosis (PA) in 20 (24%). Seventy-one percent of patients in the HA group corresponded to ASA IV/V, compared with 35% in the group with primary anastomosis (P < 0.001). Patients with Hartmann resection had also a higher MPI (23 ± 8) vs those with primary anastomosis (18 ± 7; P < 0.004). However, differences between the HA group and the PA group due to post-operative morbidity (21% vs 35%) and mortality (35% vs 20%) did not reach statistical significance. Nevertheless, multivariate analysis of the whole series revealed a significant relationship between MPI and mortality (P < 0.0043), independent of ASA class, age and operative procedure. Conclusion Patients assigned to Hartmann procedure had more co-morbidities and more advanced peritonitis as assessed by increased ASA and higher MPI. The Mannheimer Peritonitis Index proved to be an independent prognostic index in estimating mortality with respect to peritonitis extension and septic status of the patient. [source] | ||||||||||