Chemoluminescence of blood and urine in diffuse appendicular peritonitis in children

The results of the study of hemiluminescence of native blood, plasma and urine in 56 children with diffuse purulent peritonitis demonstrate that changes of light-sum of the luminescence of the investigated media could reflect aggravation of endogenous intoxication connected with development of organic insufficiency. The usage of blood and urine hemiluminescence for definition of the gravity of endogenous intoxication in diffuse forms of appendicular peritonitis in children is suggested.     

Study of leukocytic enzymes in patients with diffuse peritonitis]

Under observation were 25 patients with grave diffuse peritonitis. Histochemically, the activity of oxidation-reduction enzymes in leukocytes of peripheral blood was determined. It was found that the control of enzymic activity at the cellular level and determination of the concentration of lactic and pyruvic acids permitted the detection of hypoxic alterations in peritonitis, provided an opportunity to judge the dynamics of the pathological process.     

State of blood flow in gastric and small-intestinal mucosa in acute diffuse peritonitis

One of the most severe complications of the postoperative period in patients with diffuse peritonitis is known to be erosive ulcerous injuries of the gastrointestinal tract mucosa (in 29 of 150 patients). The blood flow state of the gastric and intestinal mucosa was studied with the help of contact microfluorimeter under conditions of experimental peritonitis. Disturbances of the intramural blood flow of the gastrointestinal tract have been found which is a cause of the formation of acute ulcers and erosions of the mucosa.     

Causes of development of peritonitis after appendectomy]

According to the authors' data peritonitis developed after appendectomy in 122 of 18347 patients, operated upon for acute appendicitis, was an extremely grave complication of this lesion and the related surgical intervention. The main causes for development of postoperative peritonitis were local and diffuse peritonitis (101 cases), more rarely--technical and tactical errors made during the operation. Due to diagnostic difficulties a purposeful treatment for postoperative peritonitis was undertaken with a delay, reoperations were performed in late terms and not in every case either. The mortality due to postoperative peritonitis made 23 per cent.     

Pharmacological correction of free radical disturbances and endotoxicosis in patients with diffuse peritonitis at the postoperative period

The examination and treatment of 64 patients have shown that inclusion of complex antioxidant cytoflavin in intensive therapy at the postoperative period of diffuse peritonitis allows the hypoxia degree to be decreased that in its turn results in quicker recovery of the antioxidant system and decreased activity of peroxidation and endotoxicosis level. The clinical course of the postoperative period of diffuse peritonitis with cytoflavin included in intensive therapy is characterized by shorter terms of artificial lung ventilation, shorter time of staying in critical condition, more favorable course of complications.     

Use of obsidan and potassium phosphate for correction of the oxygen transport function of the blood in peritonitis

The parameters of ABC, blood gases, content of nonorganic phosphorus, 2,3 DPG and ATP in erythrocytes were studied in 161 patients with diffuse peritonitis during the early postoperative period. Considerable alterations of the oxygen transport function of blood in these patients were found. The use of Obzidan and monosubstituted potassium phosphate prevents a decrease of nonorganic phosphorus, 2,3 DPG and ATP in erythrocytes, improves the oxygen supply of the organism. The time of treatment is shorter.     

Effect of retabolyl on the blood protein composition and outcome of the disease in acute peritonitis]

In 81 patients with acute diffuse peritonitis and in 38 -- with local peritonitis the authors have studied dynamically changes in the content of total protein, protein fractions in the peripheral blood, and also in the albumin -- globulin coefficient. A comparative estimation of disorders in the blood protein content and issues of the disease, depending on the use of an anabolic steroid -- retabolyl, is given. Application of retabolyl in the complex therapy enabled to reduce the number of complications and lethal issues in operated patients with diffuse peritonitis.     

Differential surgical therapy in diffuse peritonitis]

96 patients were operated on for diffuse peritonitis from January 1986 to June 1990. They underwent a differentiated therapeutical concept according to the severity of the underlying peritonitis. Mild forms were handled with the standard approach, while mid-severe cases were treated by continuous postoperative peritoneal lavage. Patients with severe peritonitis were operated on by open abdomen management. Mortality was 32% (31/96) and with that obviously better than the statistically expected mortality, based on the Mannheim-Peritonitis-Score (49%). The same findings could be demonstrated in the therapeutic subgroups. The management of diffuse peritonitis using such a differentiated surgical concept seems to be an effective approach to reduce mortality rates.     

The use of plasma from donor convalescent patients in the combined treatment of peritonitis]

The article analyses the treatment of 12 patients with diffuse purulent peritonitis in whom the titers of specific antibodies against microflora causing peritonitis were corrected in the period of secondary immunodeficiency. The authors suggest a new method for the treatment of peritonitis which is based on inclusion of convalescents' plasma after peritonitis in the therapeutic complex. This plasma contains specific antibodies against the cultured microflora in high titers and is a polyvalent hyperimmune medium which makes it possible to cause an effect on the level of humoral immunity. This improved the results of treatment: the titres of specific antibodies against the cultured microflora grew, such complications of diffuse peritonitis as the formation of circumscribed abscesses in the abdominal cavity and suppuration of the postoperative wound were encountered less frequently, mortality reduced by 16.6% as compared to the control group. The efficacy of the suggested methods was also proved in experiments on 164 animals.     

Besonderheiten der postoperativen Peritonitis

Postoperative peritonitis is still a life-threatening complication after abdominal surgery and approximately 10,000 patients annually develop postoperative peritonitis in Germany. Early recognition and diagnosis before the onset of sepsis has remained a clinical challenge as no single specific screening test is available. The aim of therapy is a rapid and effective control of the source of infection and antimicrobial therapy. After diagnosis of diffuse postoperative peritonitis surgical revision is usually inevitable after intestinal interventions. Peritonitis after liver, biliary or pancreatic surgery is managed as a rule by means of differentiated therapy approaches depending on the severity.     

Comparative evaluation of the course of peritonitis caused by anaerobic non-Clostridia and aerobic bacteria]

Comparative estimation of clinical course and postoperative complications was done in 134 patients, operated on for diffuse and generalized peritonitis, caused by anaerobic nonclostridial microorganisms in 74 (55.2%) of them and aerobic--in 60 (44.8%). More severe course and enhanced frequency of the peritonitis complications occurrence, caused by anaerobic microorganisms, was noted. The studying of characteristic peculiarities of peritonitis permits to perform purposeful antibacterial therapy even when bacteriological identification of initiating microorganism is impossible.     

The first-reported case of diffuse purulent peritonitis in a patient with retroperitoneal Hodgkin disease (etiopathogenetic hypotheses)

We report a case of purulent diffuse peritonitis in a patient who was affected by Hodgkin lymphoma, with no evidence of other abdominal diseases. This is a 54 y. old. white male who was admitted to our department with a history of asthenia, recurrent fever, dysphagia and abdominal pain. In the plain abdominal radiology pneumoperitoneum was evident. Duodenal perforation suspicion was confirmed by anamnesis and plain radiology which showed the presence of intra abdominal air. Emergency exploratory laparotomy showed a purulent diffuse peritonitis, which relapsed after multiple surgical toilettes and peritoneal lavage. A postoperative abdominal CT scan and histology of a biopsy taken during the second surgical operation showed a retroperitoneal Hodgkin lymphoma, which went to remission after chemotherapy. Considering the two simultaneous clinical manifestations (retroperitoneal Hodgkin lymphoma and peritonitis), we made two pathogenetic hypotheses: a) The retroperitoneal disease produced lymphatic stagnation and peritoneal transudation, which then was infected; b) The abnormal lymph nodes were infected and the abdominal cavity was contaminated from retroperitoneum from blood/lymphatic stream or by contiguity.     

A method of treating diffuse postoperative peritonitis

The results of autopsy of 184 patients, who died in diffuse peritonitis, are analysed. The impaired leakproof state of the hollow abdominal organs was the most common cause of postoperative peritonitis. Eighty four relaparotomies were performed for peritonitis. In 7 patients, the programmed peritoneal lavage was used. For temporary closure of the abdomen, the polyurethane film was used. In all the patients, the signs of peritonitis were liquidated. Two patients died.     

Immunologic effect of hemosorption in patients with acute peritonitis

An examination of 65 patients with acute diffuse peritonitis has shown that pronounced T-immune deficiency is observed in the postoperative period of acute peritonitis. Hemosorption was shown to be efficient in patients with high content of toxin which allows considering the method of extracorporeal detoxication as effective means of immune-correcting therapy in peritonitis patients with high level of toxinemia who make up a group of risk.     

Modern detoxication methods in surgical patients

The therapeutic possibilities of peritoneal dialysis, hemodialysis, and hemo- and lymphosorption in the treatment of the intoxication syndrome were studied in 786 patients. The causes of the intoxication syndrome were as follows: postoperative peritonitis (98), acute renal insufficiency of various etiology (493), acute hepatorenal insufficiency with exogenous poisoning (178), diffuse purulent peritonitis (11), pancreatogenic peritonitis (6). Enzymatic lavage and peritoneal dialysis were applied in 98 patients, hemodialysis methods in 493, hemosorption was conducted 360 times in 178 patients and lymphosorption in 17 patients. The efficacy of the modern methods of detoxification of the organism was demonstrated, which was evaluated from the patients' improved general condition, improvement of the values of hemodynamics, concentration of toxic metabolites and middle-mass molecules in the blood, and the results of the paramecium test.     

Results and prospects of treatment of general forms of peritonitis

956 patients with general peritonitis were operated: 596 patients--for diffuse peritonitis, 360--for general peritonitis. The causes of peritonitis were: perforating gastroduodenal ulcers (454), acute destructive appendicitis (190), acute destructive cholecystitis (82), perforation of small intestine and colon (96), postoperative peritonitis (80), other diseases (54). In low degree of bacterial contamination of abdominal cavity (not more Ig 5 CFU/g) operations were completed without abdominal drainage, laparoscopic variant of the operation being optimal. In postoperative period, out of 691 patients with low degree of bacterial contamination wound infection was in 7.9%, intraabdominal infection--in 2.5%, polyorganic insufficiency--in 1.0%; lethality was 5.9%. In high degree of bacterial contamination (more Ig 5 CFU/g) and massive unremovable fibrinous patch on the peritoneum the programmed revisions and sanations of abdominal cavity were performed, sometimes--control laparoscopic revisions. In postoperative period of 256 patients with high degree of bacterial contamination wound infection arose in 6.0%, intraabdominal infection--in 4.2%, polyorganic insufficiency [symbol: see text] in 42.6%; lethality was 18.1%.     

Hyperbaric oxygenation in the overall treatment of diffuse peritonitis in children

From 245 examined children with diffuse appendicular peritonitis hyperbaric oxygenation was used in 127 children in the complex treatment during the postoperative period. The comparative evaluation of the efficiency of the complex therapy of peritonitis with the use of hyperbaric oxygenation and without it shows a high therapeutic effect of such combination. The patients quicker get the better of a grave postoperative state and have less complications. The mortality is lower. The patients spend less time in the intensive therapy room and at the hospital.     

New approaches to the surgical treatment of diffuse peritonitis]

OBJECTIVE: We intend to analyze if additional treatment concepts are necessary in any case as a part of the standard therapy next to the well established principle of source control in the treatment of secondary peritonitis. DESIGN: A treatment concept with early intervention, source control and extensive intraoperative lavage (20-301) should be evaluated as a standard procedure in a prospective survey. Additional treatment concepts will be applied only for special reason (on demand). RESULTS: From 11/1993 to 9/1997 241 patients with diffuse peritonitis were treated with the concept mentioned above. Additional treatment concepts as continuous postoperative lavage (n = 20) and staged lavage (n = 4) were applied as primary treatment in 24 patients only (10%), mainly for impossibility of source control and evisceration. Source control at the initial operation was possible in 216 patients (90%). Due to secondary evisceration 3 patients had to undergo laparostomy for staged lavage later. Severity of peritonitis was determined according to the Mannheim Peritonitis Index (median 26, range 15-43). The primary causes of peritonitis were perforation, leakage and abscess after operation (n = 56), followed by diverticular (n = 42) and gastric or duodenal perforation (n = 39). The hospital mortality rate was 14% in the whole group, and the postoperative morbidity rate was 39%. CONCLUSIONS: Due to progress in intensive care and antibiotic treatment only a few patients (ca. 10%) need additional therapies such as postoperative or staged lavage. Surgical source control in combination with intraoperative lavage is sufficient in most of the patients with diffuse peritonitis.     

The anti-hypoxic agent influence on the early postoperative period course in patients with peritonitis

In 70 patients with diffuse peritonitis, occurred in early postoperative period, preparation lipine was included in complex of treatment, promoting the results of treatment improvement.     

Peritoneal biofilms: microscopic features

Antibiotherapy remains one of the basic clinical tools, which can influence the evolution of severe peritonitis. Peritoneal biofilm formation may minimize the antibiotic effects due to dramatic growth of Minimum Inhibitory Concentrations (MIC) and Minimum Bactericidal Concentrations (MBC) for matrix-enclosed bacteria. In this paper we demonstrate the presence and evolution of bacterial biofilms on the peritoneal surface during the course of severe secondary peritonitis using an experimental model and clinical material. Cecal Ligation Puncture was performed in 20 mice Swiss Webster. Peritoneal samples were studied at optic and electronic microscope at 10, 24, 48 and 72 hours postoperative. Clinical samples were taken from 10 patients with diffuse peritonitis. At 24 hours after the onset of the peritonitis bacterial colonies were detected on the peritoneal surface. The formation of mature multilayer polymicrobial biofilms with deep penetration in abdominal wall by 48-72 hours was documented. The bacterial biofilms appear in first 24 hours in the course of experimental generalized peritonitis. Our experimental and clinical data demonstrate formation of the mature polymicrobial biofilm in 48-72 hours after the onset of peritonitis. The possibility of resistant biofilm formation in secondary diffuse peritonitis should be taken into consideration in elaboration of treatment schemes.