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Review
. 2006 Dec;86(6):1323-49.
doi: 10.1016/j.suc.2006.09.006.

Management of peritonitis in the critically ill patient

Carlos A Ordoñez  1 , Juan Carlos Puyana
Affiliations
Review

Management of peritonitis in the critically ill patient

Carlos A Ordoñez et al. Surg Clin North Am. 2006 Dec.

Abstract

Severe secondary peritonitis carries significant mortality, despite advancements in critical care support and other therapies. Surgical management requires a multidisciplinary approach to guide the timing and the number of interventions necessary to eradicate the septic foci and create optimal healing with the fewest complications. Research is needed regarding the best surgical strategy for very severe cases. The use of deferred primary anastomosis seems safe in patients presenting with hemodynamic instability and hypoperfusion. These patients have a high risk of anastomotic failure and fistula formation. Allowing for aggressive resuscitation and judicious assessment of the progression of local inflammation are safe strategies to achieve the highest success and minimize serious and protracted complications in patients who survive the initial septic insult.

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Figures

Fig. 1
Fig. 1
Temporary closure proximal and distal with umbilical tape.
Fig. 2
Fig. 2
Side-to-side anastomis with GIA 80 4.8.
Fig. 3
Fig. 3
GIA 80 4.8 stapled anastomosis to close bowel ends.
Fig. 4
Fig. 4
Anastomosis completed.
See this image and copyright information in PMC

References

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Publication types