Treatment of purulent diffuse peritonitis

1927 ◽  
Vol 23 (3) ◽  
pp. 351-352
Author(s):  
A. Timofeev
Keyword(s):  
Abdominal Cavity ◽  
Harmful Effect ◽  
Diffuse Peritonitis ◽  
Infectious Focus ◽  
Perforative Peritonitis

The author reports that in Petrivalskis' clinic in the treatment of diffuse perforative peritonitis drainage is not used if the infectious focus is removed; abscesses are drained; antiseptics are also not used due to their harmful effect on the vital properties of the peritoneal endothelium, but it is recommended to infuse 50-100 cc into the abdominal cavity. 3% solution of hydrogenii superoxydati, and the resulting foam mechanically cleans the abdominal cavity, and the released oxygen produces oxidation of toxins.

scholarly journals The first experience of stapled intestinal anastomoses application in children in Ukraine

2020 ◽  
pp. 15-20
Author(s):  
O. Sliepov ◽  
◽  
M. Migur ◽  
O. Ponomarenko ◽  
O. Gladyshko ◽  
...  
Keyword(s):  
Body Weight ◽  
Necrotizing Enterocolitis ◽  
Postoperative Period ◽  
Abdominal Cavity ◽  
Operation Time ◽  
Developed Countries ◽  
Premature Baby ◽  
Diffuse Peritonitis ◽  
Level Of Evidence ◽  
Intestinal Anastomoses

Introduction. Conducting reconstructive surgery in children, especially those with low body weight, associated with an increase in the operation time and a worsening of the postoperative period. Therefore, to reduce the operation time, surgical clinics in developed countries of the world use linear staplers for anastomoses in children, especially young children. Case report. A premature newborn, with a birth weight of 1420 g, was diagnosed with necrotizing enterocolitis, with ileal perforation and diffuse peritonitis. According to vital indications, the operation was performed: laparotomy, revision of the abdominal cavity, Mikulich enterostomy. After complete stabilization of the general condition of the child, upon reaching 2550 g of body weight, at the age of 2 months, enterostomy closure was performed with the imposition of a stapled side-to-side functional end-to-end ileoileostomy. In 14 days after the operation, the child achieved full enteral autonomy. There were no postoperative surgical complications. In the late postoperative period, the child gains weight well, grows and develops according to age. Conclusion. The use of linear staplers in time of enteroanastomoses creation can significantly reduce operation time in children, in particular, premature babies with low body weight. Level of evidence. Level V. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an participating institution.The informed consent of the child’s parents was obtained from the studies. No conflict of interest was declared by the authors. Key words: linear staplers, enteroanastomosis, necrotizing enterocolitis, perforation of the small intestine, newborn premature baby.

Treatment of purulent peritonitis

1927 ◽  
Vol 23 (5) ◽  
pp. 586-587
Author(s):  
A. Timofeev
Keyword(s):  
Intravenous Injection ◽  
Abdominal Cavity ◽  
Early Operation ◽  
Sugar Solution ◽  
Infectious Focus ◽  
Purulent Peritonitis

The author treats purulent peritonitis as follows: early operation is possible, and, if circumstances permit, it is useful to pre-prepare the patient with napertia, coffein, and intravenous injection of 20 cc. 40% grape sugar solution to reduce the danger of anesthesia to the heart; the site of the incision is chosen according to the localization of the process; the wound is lubricated with Peruvian balsam before opening the peritoneum; if peritonitis spills over, the abdominal cavity is flushed; if the infectious focus can be reliably turned off, drainage is not necessary; wire sutures. Careful stretching of rectal stomas after surgery facilitates the evacuation of gases and feces.

scholarly journals Diagnostics and treatment of abdominal complications after gynecological endoscopic operations

2021 ◽  
Vol 1 ◽  
pp. 75-79
Author(s):  
Yu.P.  Vdovichenko ◽  
V.I.  Boyko ◽  
V.A.  Terehov
Keyword(s):  
Postoperative Complications ◽  
Postoperative Period ◽  
Diagnostic Laparoscopy ◽  
Abdominal Cavity ◽  
Early Postoperative Period ◽  
Main Group ◽  
Laparoscopic Technique ◽  
Control Group ◽  
Diffuse Peritonitis ◽  
Abdominal Complications

The objective: to analyze the results of repeated laparoscopy in gynecological patients with suspected intraperitoneal postoperative complications.Materials and methods. The study involved 42 patients (mean age 46±11,3 years), in whom postoperative abdominal complications after surgical treatment of various gynecological diseases required repeated operations. Depending on the method of re-intervention, the patients were divided into 2 groups: the main group (n=20) – women who only used laparoscopy to correct postoperative complications; control (n=22) – women who were given indications for relaparotomy to correct postoperative complications during diagnostic laparoscopy. Relaparotomy was performed in 8 patients of the control group. All patients underwent a comprehensive examination using clinical, instrumental and laboratory research methods. The groups were homogeneous in terms of age and structure of operations performed on the pelvic organs, and statistically comparable.Results. During the study, the results of repeated laparoscopy of 34 gynecological patients with suspected intraperitoneal postoperative complications were analyzed. In all patients of the main group (47,6%), laparoscopy was revealed as the only and final method of treatment of postoperative complications, while in 7 women repeated relaparoscopy was used from 2 to 4 times, and in 13 women laparoscopy was performed once. In the control group (53,3%), 10 patients during diagnostic laparoscopy were exposed to indications for relaparotomy, in 4 patients the capabilities of the operating team and laparoscopic technique allowed performing some elements of the operation and completing it with a minilaparotomy approach, and 8 patients underwent relaparotomy immediately.Peritonitis and intraperitoneal bleeding prevail in the structure of early abdominal complications. The use of the video laparoscopic technique made it possible in 28,6% of patients with diffuse peritonitis to successfully eliminate the developed complication, eliminate its source and sanitize the abdominal cavity. Laparoscopic hemostasis was successfully performed in 7 patients.Compared with the standard, the use of video endoscopic technique allowed improving the indicators of diagnostic value: to increase the sensitivity level by 1,07 times, specificity by 1,39 times and diagnostic accuracy by 1,11 times.Conclusion. In general, in the early postoperative period, 47 relaparoscopies were performed for suspected complications, which is explained by programmed abdominal sanitization and the use of dynamic laparoscopy to control the course of intraperitoneal complications. Based on the analysis of the material under study, we proposed general indications and contraindications for relaparoscopy in the early postoperative period in order to diagnose and treat postoperative complications. Justifying each of the points, we were guided by the real possibilities of the method in general clinical practice, which in some cases are inferior in their effectiveness to relaparotomy.

scholarly journals Abdominal sepsis

2020 ◽  
pp. 231-233
Author(s):  
M.Yu. Nychytailo
Keyword(s):  
Damage Control ◽  
Abdominal Cavity ◽  
Abdominal Sepsis ◽  
Resistant Bacteria ◽  
Diffuse Peritonitis ◽  
Damage Control Laparotomy ◽  
Adequate Control ◽  
Source Of Infection ◽  
Infection Source ◽  
Temporary Closure

Background. Sepsis is a life-threatening acute organ dysfunction that occurs as a result of dysregulation of the macroorganism’s response to infection. Septic shock is a variant of sepsis characterized by the circulatory failure, manifested by hypotension and increased lactate levels >2 mmol/L despite adequate infusion, which requires the administration of vasopressors to maintain average blood pressure >65 mm Hg. Objective. To describe the management of patients with abdominal sepsis. Materials and methods. Analysis of literature data on this topic. Results and discussion. Complicated intra-abdominal infection (IAI) is the growth of pathogenic microorganisms in a usually sterile abdominal cavity, usually due to the perforation of the hollow organs. Uncomplicated IAI involves transmural inflammation of the digestive tract, which does not spread beyond the hollow organ. If uncomplicated IAI are not treated, there is a possibility that they will progress to complicated ones. Measures to control the source of infection include the drainage of abscesses or places of accumulation of infected fluid, removal of necrotic infected tissues and restoration of the anatomy and functions of the affected area. Several multivariate studies have found that failure to adequately control the source of infection is a risk factor for adverse outcomes and death in patients with IAI. Surviving sepsis and other recommendations also support the need for early control of the source of infection. In a study by B. Tellor et al. (2012) mortality was 9.5 % among individuals with adequate control of the infection source and 33.3 % among patients who failed to achieve such control. In some situations, it is advisable to manage patients conservatively. Thus, in appendicular infiltration, most studies have demonstrated the benefits of conservative management (Andersson R.E., Petzold M.G., 2007). Management of IAI without final control of the primary source is possible in cases where the organism has already overcome the infection, and surgery can only increase the number of complications. In general, patients with localized infections may need less invasive management. Thus, percutaneous drainage can be used for localized accumulations of fluid in the abdominal cavity. 80-92 % of drainage procedures are successful on the first attempt. <5 % of patients require surgical treatment. Such drainage procedures are used in infected pancreatic necrosis, and the final debridement of the infection source may be delayed. In critically ill patients, damage control laparotomy and limited intervention (resection without reanastomosis or stoma formation, temporary drainage and tamponade of the abdominal cavity if necessary, temporary closure of the abdominal cavity) are performed to control the infection. Indications for damage control laparotomy include inability to achieve adequate control of the source of IAI during primary laparotomy, hemodynamic instability, the need to re-evaluate the condition of the problematic anastomosis, and diffuse peritonitis. A prospective study of staged laparotomies revealed a shorter length of stay in the intensive care unit, a lower incidence of complications and lower treatment costs using this method compared to the standard one. Antibacterial support of surgical interventions is an important aspect of treatment. In conditions of increasing antibiotic resistance, antibiotics should be prescribed strictly in accordance with the recommendations and for as short effective period as possible. Conclusions. 1. Despite the fact that approaches are changing, control of the IAI source remains the main method of treatment of most patients with IAI. 2. The choice of empirical antibacterial therapy should be based on the risk assessment and potential of resistant bacteria. 3. The duration of antimicrobial therapy can be significantly reduced (4 days).

scholarly journals CONTROL OF APPLICATION EFFICACY OF THE ASCENDING GAS - FLUID STREAM METHOD IN TREATMENT OF DIFFUSE PERITONITIS

2015 ◽  
Vol 174 (5) ◽  
pp. 18-21
Author(s):  
S. I. Remizov ◽  
I. V. Remizov ◽  
Yu. P. Savchenko
Keyword(s):  
Inflammatory Process ◽  
Abdominal Cavity ◽  
Lavage Fluid ◽  
Diffuse Peritonitis ◽  
Fluid Stream ◽  
Clinical Indices

The ascending gas and fluid stream method was applied in 12 patients with repeated purulent diffuse peritonitis. The number of leukocytes was determined in lavage fluid in order to estimate the efficacy of the method. Dynamics of general laboratory and clinical indices was compared with dynamics of leukocytes quantity. The research showed the adequacy of investigation results of lavage fluid to the course of inflammatory process in the abdominal cavity. The study presented an application possibility of given test for regulation usage correction of the ascending gas-fluid stream method.

scholarly journals Spontaneous Rupture of Pyometra

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Fatemeh Mallah ◽  
Tahere Eftekhar ◽  
Mohammad Naghavi-Behzad
Keyword(s):  
Abdominal Pain ◽  
Gastrointestinal Tract ◽  
Rare Complication ◽  
Abdominal Cavity ◽  
Clinical Findings ◽  
Diffuse Peritonitis ◽  
Spontaneous Perforation ◽  
Definite Diagnosis ◽  
Incarcerated Hernia ◽  
First Case

Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen. In most cases, a correct and definite diagnosis can be made only by laparotomy. We report two cases of diffuse peritonitis caused by spontaneous perforated pyometra. The first case is a 78-year-old woman with abdominal pain for which laparotomy was performed because of suspected incarcerated hernia. The second case is a 61-year-old woman with abdominal pain for which laparotomy was performed because of symptoms of peritonitis. At laparotomy of both cases, 1 liter of pus with the source of uterine was found in the abdominal cavity. The ruptured uterine is also detected. More investigations revealed no malignancy as the reason of the pyometra.

scholarly journals Methodology for assessing the severity of diffuse peritonitis and prognosis of relaparotomy

2021 ◽  
Vol 180 (2) ◽  
pp. 21-27
Author(s):  
B. V. Sigua ◽  
V. P. Zemlyanoy ◽  
S. V. Petrov ◽  
V. A. Ignatenko ◽  
P. A. Kotkov
Keyword(s):  
High Risk ◽  
Abdominal Cavity ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
Clinical Effectiveness ◽  
Diffuse Peritonitis ◽  
Surgical Interventions ◽  
Surgical Infection ◽  
Tertiary Peritonitis ◽  
Number Of Patients

INTRODUCTION. The problem of treating patients with peritonitis has always been and still remains relevant in surgery. Moreover, aspects of treating patients with tertiary peritonitis requiring repeated interventions are of particular importance. The OBJECTIVE of this work was to develop and evaluate the clinical effectiveness of a score-prognostic scale that allows to identify groups of patients with a high risk of persistent surgical infection in the abdominal cavity, in which a single intervention cannot be considered effective even despite the elimination of the primary surgical infection focus.METHODS AND MATERIALS. To achieve the goal, a correlation was evaluated between a number of factors and the likelihood of relaparotomy in a retrospective group consisting of 111 patients with secondary peritonitis. Based on the achieved data, score-prognostic scale for assessing the severity of peritonitis was developed, which allowed to formulate an algorithm of surgical tactics, which was used in the treatment of 109 patients. A group of 34 people with a high risk of tertiary peritonitis development was allocated from the number of patients – of which 20 patients had a total number of 39 planned surgical interventions.RESULTS. The use of the developed scale led to an increase in the total number of surgical interventions, however, reducing postoperative mortality by 1.7 times (p = 0.001) mainly due to improved survival rates in the group of patients with severe forms of peritonitis.CONCLUSION. The obtained results allowed to recommend the developed integral prognostic scale for assessing the severity of peritonitis for use in clinical practice.

scholarly journals RESEARCH ON THE EFFICIENCY OF THE USE OF THE SORBENT COMBINATION AND ANTISEPTICS IN THE COMPLEX TREATMENT OF PERITONITIS

2020 ◽  
pp. 63-66
Author(s):  
I. I. Bilуk ◽  
B. V. Petriuk ◽  
O. V. Rotar ◽  
I. I. Dutka ◽  
I. E. Semeniuk
Keyword(s):  
Escherichia Coli ◽  
Postoperative Complications ◽  
Bacterial Contamination ◽  
Abdominal Cavity ◽  
Population Level ◽  
Peritoneal Exudate ◽  
Diffuse Peritonitis ◽  
Complex Treatment ◽  
Combined Use ◽  
Taxonomic Groups

Summary. The aim of the study was to investigate the effectiveness of using a combination of antiseptic and sorbent for decontamination of the abdominal cavity in patients with diffuse peritonitis. The study of isolated peritoneal exudate obtained in patients with diffuse appendicular peritonitis. The exudate determined the species composition and population level of the micro flora before and during the 24-hour incubation without sorbent and antiseptic and their combined use. Bench studies have shown that peritoneal exudate of patients with acute appendicitis, complicated by peritonitis, is contaminated with microorganisms belonging to different taxonomic groups. The anaerobic-aerobic associations of bacterroids, Escherichia coli and fecal enterococcus were dominant among the detected microorganisms. With in 24 hours of incubation, the population level of exudate micro flora increased, which was incubated without sorbent and antiseptic. In a series of studies where the exudate was incubated with the sorbent, a significant decrease in the population level of the micro flora was observed. The combination of sorbent and antiseptic retained its detoxifying and decontaminating properties with respect to toxic factors and pathogens of peritoneal exudate throughout the incubation period, however, the most pronounced properties were observed during the first 12 hours of incubation. Their combined use has been shown to reduce bacterial contamination of peritoneal exudate and reduce the risk of postoperative complications.

scholarly journals Modern approaches to abdominal drainage in diffuse peritonitis

2015 ◽  
Vol 96 (3) ◽  
pp. 385-390
Author(s):  
E K Salakhov ◽  
K K Salakhov
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Abdominal Cavity ◽  
Diffuse Peritonitis ◽  
Present Stage ◽  
Abdominal Drainage ◽  
Medical Technologies ◽  
Frequency Of Use ◽  
Improved Methods

An overview of domestic and foreign literature reflecting modern approaches to abdominal drainage in diffuse peritonitis is presented. Materials and methods of drainage are described, the results of some randomized clinical trials exploring the effectiveness of abdominal drainage are analyzed. This medical manipulation is one of the first methods of debridement, which does not lose importance to this day, despite a long history. Drains reduce and inhibit the antibacterial and absorbent function of the peritoneum. At this stage, silicone drains, known for flexibility, durability and the possibility of long-term use are widespread. Use of drainages is limited in time, as they are not biologically inert and become bounded from the abdominal by adhesions and fibrin deposits. So far, there are heated debates about how to drainage, drainage installation method, frequency of use and indications. Good performance of the drainages can be achieved only if they function constantly, like in abdominal dialysis. Of course, this does not mean that drains should not be used in treatment of peritonitis, but they should be placed under strict indications. Thus, despite the large experience, the question of the abdominal drainage utility at peritonitis remains open, as currently applied improved methods for drainage have several disadvantages and the use of any method is often controversial. The development of new, highly effective methods of abdominal cavity debridement in peritonitis is an actual task, especially at the present stage of medical technologies development.

scholarly journals Boerhaave syndrome in emergency abdominal surgery

2016 ◽  
Vol 97 (6) ◽  
pp. 963-966
Author(s):  
V F Chikaev ◽  
Yu V Bondarev ◽  
A L Mavzyutov ◽  
E S Sorokina
Keyword(s):  
Diaphragmatic Hernia ◽  
Spontaneous Rupture ◽  
Abdominal Cavity ◽  
Double Lumen Tube ◽  
Esophageal Wall ◽  
Diffuse Peritonitis ◽  
Esophageal Rupture ◽  
Double Lumen ◽  
Left Wall ◽  
Retrosternal Pain

Aim. To present a case of spontaneous rupture of esophagus taking into account its rarity, diversity of clinical manifestations, complexity of making a diagnosis and treatment of this disease.Methods. Over the past three years in Kazan City Clinical Hospital №7 three cases of the esophageal damage were registered. The age of the patients ranged from 48 to 67 years, including 2 females and 1 male with spontaneous rupture of esophagus.Results. A 48-year old patient was admitted to the hospital complaining of vomiting with blood followed by appearance of retrosternal pain which appeared immediately after the holiday and nutritional stress. Emergency fibrogastroduodenoscopy (FEGDS) was performed. Endoscopy revealed signs suggestive of diaphragmatic hernia, and 2 ruptures of esophageal mucous membrane up to 3 cm on the left wall of esophagus above the cardiac sphincter. The diagnosis of Mallory-Weiss syndrome complicated with bleeding was made. Surgery: laparotomy, abdominal revision. The abdominal cavity had dark hemorrhagic discharge, inflamed peritoneum and signs of diffuse peritonitis. Diaphragmatic crurotomy was performed. Revision of abdominal esophagus revealed two longitudinal ruptures of the left esophageal wall 1.5 and 3 cm long 8 cm up from the cardiac sphincter. The ruptures were sutured by discontinuous atraumatic encircling stitch. Lower mediastinum was drained with two double-lumen tubes, the gastric probe was installed through the nose. During the follow up CT scan and ultrasound of thoracic cavity were performed. Liquid nutrition through the probe lasted up to 20 days. The mediastinum was lavaged through double-lumen tube with an aqueous solution of chlorhexidine and chymotrypsin up to 32 days. The patient was discharged on day 34 in a satisfactory condition.Conclusion. One of the etiologic factors of spontaneous esophageal rupture may be diaphragmatic hernia of the esophagus with increased intraesophageal pressure; early surgical intervention, suturing of esophageal rupture, mediastinal drainage and lavage in the postoperative period are fundamental steps in the treatment of esophageal rupture.

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