Peritonitis: Priorities and Management Strategies

  • G. Sganga
  • G. Brisinda
  • M. Castagneto
Conference paper
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


Despite advances in antimicrobial and surgical therapies, severe peritonitis remains a potentially fatal disease. Furthermore, infections due to spontaneous gastrointestinal perforation and those resulting from injuries or complications of abdominal operations, still represent a challenge for surgeons.


Abdominal Compartment Syndrome Intraabdominal Abscess Intraabdominal Infection Secondary Peritonitis Obligate Anaerobe 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Bosscha K, van Vroonhoven JMV, van der Werken C (1999) Surgical management of severe secondary peritonitis. Br J Surg 86: 1371–1377PubMedCrossRefGoogle Scholar
  2. 2.
    Goris RJA, to Boekhorst TPA, Nuytinck JKS, Gimbrere JSF (1985) Multiple-organ failure: generalized autodestructive inflammation? Arch Surg 120: 1109–1115PubMedCrossRefGoogle Scholar
  3. 3.
    Marshall JC, Sweeney D (1990) Microbial infection and the septic response in critical illness. Arch Surg 125: 17–23PubMedCrossRefGoogle Scholar
  4. 4.
    Bone RG, Balk RA, Cerra FB et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicins/Society of Critical Care Medicine. Chest 101: 1644–1655Google Scholar
  5. 5.
    Wittmann DH, Walker AP, Condon RE (1993) Peritonitis, intra-abdominal infection, and intra-abdominal abscess. In: Schwartz SI, Shires GT, Spencer FC (eds) Principles of surgery, 6th edn. McGraw-Hill, New York, pp 1449–1484Google Scholar
  6. 6.
    Wittmann DH (1990) Symposium of intra-abdominal infections: introduction. World J Surg 14: 145–148PubMedCrossRefGoogle Scholar
  7. 7.
    Rotstein OD, Meakins IL (1990) Diagnostic and therapeutic challenges of intra-abdominal infections. World J Surg 14: 159–166PubMedCrossRefGoogle Scholar
  8. 8.
    Rotstein OD, Simmons RL (1994) Peritonitis and intraabdominal abscess. In Barie PS, Shires GT (Eds) Surgical Intensive Care. Little Brown, Boston, pp 1043–1063Google Scholar
  9. 9.
    Schein M (1992) Management of severe intra-abdominal infection. Surg Annu 24: 47–68PubMedGoogle Scholar
  10. 10.
    Wittmann DH, Schein M, Condon RE (1996) Management of secondary peritonitis. Ann Surg 224: 10–18PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Bohnen J, Boulanger M, Meakins JL, McLean AP (1983) Prognosis in generalized peritonitis: relation to cause and risk factors. Arch Surg 118: 285–290PubMedCrossRefGoogle Scholar
  12. 12.
    Meakins JL, Solomkin JS, Allo MD et al (1984) A Proposed classification of intra-abdominal infections. Arch Surg 119: 1372–1378PubMedCrossRefGoogle Scholar
  13. 13.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13: 818–829PubMedGoogle Scholar
  14. 14.
    Finegold SM (1982) Microflora of the gastrointestinal tract. In: Wilson SE, Finegold SM, Williams RA (eds) Intra-abdominal infection. McGraw-Hill, New York, pp 1–22Google Scholar
  15. 15.
    Krepel CJ, Gohr CM, Edmiston CE, Condon RE (1995) Surgical sepsis: constancy of antibiotic susceptibility of causative organisms. Surgery 117: 505–509PubMedCrossRefGoogle Scholar
  16. 16.
    Bartlett JG, Onderdonk AB, Louie TJ, Kasper DL (1978) A review: lesson from an animal model of intra-abdominal sepsis. Arch Surg 113: 853–857PubMedCrossRefGoogle Scholar
  17. 17.
    Maddaus MA, Ahrenholz D, Simmons RL (1988) The biology of peritonitis and implications for treatment. Surg Clin North Am 68: 431–433PubMedGoogle Scholar
  18. 18.
    Parrillo JE (1993) Pathogenic mechanisms of septic shock. N Engl J Med 328: 1471–1477PubMedCrossRefGoogle Scholar
  19. 19.
    Marshall JC, Christou NV, Meakins JL (1993) The gastrointestinal tract: the “undrained abscess” of multiple organ failure. Ann Surg 218: 111–119PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Holzheimer RG, Schein M, Wittmann DH (1995) Inflammatory mediators in plasma and peritoneal exudate of patients undergoing staged abdominal repair ( STAR) for severe peritonitis. Arch Surg 130: 1314–1320Google Scholar
  21. 21.
    Gabay C, Kushner I (1999) Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 340: 448–454PubMedCrossRefGoogle Scholar
  22. 22.
    Deitch EA (1993) Cytokines yes, cytokines no, cytokines maybe? Crit Care Med 21: 817819Google Scholar
  23. 23.
    Palmer RMJ (1993) The discovery of nitric oxide in the vessel wall. Arch Surg 128: 396-401Google Scholar
  24. 24.
    Sganga G, Gangeri G, Montemagno S, Castagneto M (1994) Prevention of translocation–prevention of multiple organ system failure. In: Mutz NJ, Koller W, Benzer H (eds.) Proceedings of the 7th European Congress on Intensive Care Medicine. Monduzzi, Bologna, pp 93–101Google Scholar
  25. 25.
    Moore FA (2000) Common mucosal immunity: a novel hypothesis. Ann Surg 231: 9–10PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Kanwar S, Windsor ACJW, Welsh F et al (2000) Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery. Ann Surg 231: 88–95PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Wittmann DH, Bergstein JM, Frantzides CT (1991) Calculated empiric antimicrobial therapy for mixed surgical infections. Infection 19 [Suppl 61: 345–350CrossRefGoogle Scholar
  28. 28.
    Solomkin JS, Meakins JL, Dellinger EP (1984) Antibiotics trials in intra-abdominal infections: a critical evaluation of study design and outcome reporting. Ann Surg 201: 29–39CrossRefGoogle Scholar
  29. 29.
    Hopkins JA, Wilson SE, Bobey DG (1994) Adjunctive antimicrobial therapy for complicated appendicitis: bacterial overkill by combination therapy. World J Surg 18: 933938Google Scholar
  30. 30.
    Solomkin JS, Dellinger EP, Christou NV, Busuttil RW (1990) Results of a multicenter trial comparing imipenem/cilastatin to tobramycin/clindamycin for intra-abdominal infections. Ann Surg 212: 581–591PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Schein M, Assalia A, Bachus H (1994) Minimal antibiotic therapy after emergency abdominal surgery: a prospective study. Br J Surg 81: 989–891PubMedCrossRefGoogle Scholar
  32. 32.
    Schein M, Cecelter G, Freinkel W, Gerding H (1990) Peritoneal lavage in abdominal sepsis: a controlled clinical study. Arch Surg 125: 1132–1135PubMedCrossRefGoogle Scholar
  33. 33.
    Farthmann EH Schöffel U (1990) Principles and limitations of operative management of intraabdominal infections. World J Surg 14:210–217Google Scholar
  34. 34.
    Barendregt W, de Bower H, Kubat K (1992) The results of autopsy of patients with surgical disease of the digestive tract. Surg Gynecol Obstet 175: 227–232PubMedGoogle Scholar
  35. 35.
    Steinberg D (1979) On leaving the peritoneal cavity open in acute generalized suppurative peritonitis. Am J Surg 137: 216–220PubMedCrossRefGoogle Scholar
  36. 36.
    Schein M, Saadia R, Decker GG (1986) The open management of the septic abdomen. Surg Gynecol Obstet 163: 587–591PubMedGoogle Scholar
  37. 37.
    Penninckx FM, Kerremans RPJ, Lauwers PM (1983) Planned relaparotomies in the surgical treatment of severe generalized peritonitis from intestinal origin. World J Surg 7: 762–766PubMedCrossRefGoogle Scholar
  38. 38.
    Teichmann W, Wittmann DH, Andreone A (1986) Scheduled reoperations ( Etappenlavage) for diffuse peritonitis. Arch Surg 121: 147–152Google Scholar
  39. 39.
    Schein M, Wittmann DH, Aprahamian C, Condon RE (1995) Abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg 180: 745–753PubMedGoogle Scholar
  40. 40.
    Kinney EV, Polk HC (1987) Open treatment of peritonitis: an argument against. Adv Surg 21: 19–28Google Scholar
  41. 41.
    Levison MA, Zeigler D (1991) Correlation of APACHE II score, drainage technique and outcome in postoperative intra-abdominal abscess. Surg Gynecol Obstet 172: 89–94PubMedGoogle Scholar
  42. 42.
    Baril NB, Rails PW, Wren SM et al (2000) Does an infected peripancreatic fluid collection or abscess mandate operation? Ann Surg 231: 361–367PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 2001

Authors and Affiliations

  • G. Sganga
  • G. Brisinda
  • M. Castagneto

There are no affiliations available

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