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Generalized Peritonitis (generalized + peritonitis)

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Medical Sciences	100%

Selected Abstracts

Emergency surgery for complicated acute diverticulitis

COLORECTAL DISEASE, Issue 2 2009
N. Issa
Abstract Aim, Antecedent attacks of diverticulitis are thought to increase the risk of complicated diverticulitis, and unless elective surgery is performed, a high proportion of patients with recurrent symptoms will require emergency operations for complicated diverticulitis with its associated morbidity. In this multicentre study, we aim to assess impact of previous attacks of diverticulitis on patients requiring an emergency surgical intervention. Method, All patients operated on as an emergency for complicated diverticulitis were retrospectively analysed. Patients were separated into two groups: group A included patients without previous history of diverticular disease, and group B those with previous attacks of diverticulitis. Results, A total of 96 patients were included in the study. Group A included 68 (70.8%) patients, and group B 28 (29.2%) patients. Generalized peritonitis was the reason for operation in 50 (73.5%) patients in-group A and only four (14%) patients in group B. Perforated diverticulitis occurred more often in group A, whereas pericolonic abscess and phlegmon formation occurred more commonly in group B. Resection was performed in all patients in group B; 50% had a Hartmann's procedure, and the other 50% patients had primary anastomosis. Hartmann's procedure was performed in 52 patients (76.5%) in group A, and 8 patients (11.7%) had resection and primary anastomosis. No difference in postoperative complications was identified between the groups. Conclusion, Multiple attacks of diverticulitis are not associated with an increased risk of complicated diverticulitis. Recurrent episodes of diverticulitis are not associated with a less favourable outcome or an increased risk of fatality if complications ensue. [source]

Potential Prognostic Indicators in Diffuse Peritonitis Treated with Open Peritoneal Drainage in the Canine Patient

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2000
DACVS, 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]

Authors' reply: Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis (Br J Surg 2008; 95: 97,101)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2009
E. Myers
No abstract is available for this article. [source]

The incidence and causes of permanent stoma after anterior resection

COLORECTAL DISEASE, Issue 4 2003
C. M. H. Bailey
Abstract Aims Defunctioning stomas are used following anterior resection to guard against the serious consequences of anastomotic leak such as pelvic sepsis and generalized peritonitis. This study aims to determine what proportion of patients undergoing anterior resection have a defunctioning stoma, how many of these patients do not have their stoma closed, and the reasons for this. Methods All patients undergoing a resection for rectal cancer in our institution in a five year period (January 1995 to December 1999) are included in the study. Anterior resection was performed on 154 patients, divided into 76 anterior resections (AR) and 78 low anterior resections (defined as the anastomosis within 6 cm of the anal verge). The data from these patients were analysed retrospectively. Results Of the total of 154 patients undergoing anterior resection, 59 (38%) were defunctioned, divided into 33 with loop ileostomy and 26 with loop colostomy. Five of these patients had not had their stoma closed at a median follow up of four years (range 1.5,6.5 years). The reasons for non closure were anastomotic stricture (2), metastatic disease (2), and patient choice (1). When comparing AR and LAR, 16% of patients had a defunctioning stoma after AR, compared with 60% after LAR (P < 0.01). Conclusion Anterior resection is being performed for very low rectal tumours in order to avoid a permanent stoma. However we have found that 8% of patients who are defunctioned with a stoma at anterior resection will not have their stoma closed, and conclude that patients should be warned of this pre-operatively. [source]

Utility of appropriate peritonitis grading in the surgical management of perforated sigmoid diverticulitis

COLORECTAL DISEASE, Issue 6 2000
K. 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]