[Postoperative peritonitis].

Abstract

This is a report on retrospective summed-up analysis of the therapeutic approach to 296 patients presenting postoperative peritonitis (PP). They account for 1.4 per cent of the total number of patients operated on in the clinic. The latter percentage differs in the single groups of patients, distributed by organic localization of the pathological process, as follows: 1.3 per cent in hepatobiliary and pancreatic diseases, and 1.9 per cent in gastroduodenal ones. In colorectal diseases the percentage grows to 8, and after the 80th year of life it falls to and below 4, amounting to 2.2 per cent during the last five years. The overall mortality rate is 69 per cent--57.7 and 72.5 per cent respectively for the three separate groups-mainly at the expense of patients presenting oncological diseases, 73.5 per cent. The underlying causes of PP development comprise: insufficiency of the anastomosis, intraoperative contamination and infection of the abdominal cavity, intraoperative oversights-technical errors, iatrogenic and foreign body, circulation derangement in the organ operated on, suture applied to cancer infiltrated and infected tissue and persisting peritonitis for which the intervention is undertaken. The diagnosis is difficult regardless of the biochemical, instrumental and microbiological examinations performed. Early relaparotomy is the only possible life-salvaging approach to the patient, its immediate goal being sanation of the source, peritoneal lavage, wide drainage and ileostomy. PP remains a problem difficult to handle irrespective of the progress of antibiotic and resuscitation treatment.