Accomplished with laparoscopy in patients with

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accomplished with laparoscopy in patients with increased intra-abdominal pressure postoperatively that is related to the accumulation of tense ascites and not intraperitoneal hemorrhage. Complications related to enteric insufficiency 34
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Extensive initial (gastrointestinal) disease, chronic recurrent infections, and associated reoperations may lead to enteric insufficiency because of short gut, pancreatic insufficiency, or hepatic dysfunction. Treatment of these problems can be quite challenging and can require a multispecialty approach to optimize gastrointestinal function and nutritional status. Outcome and Prognosis Spontaneous bacterial peritonitis The overall mortality rate of patients with SBP may exceed 30% if diagnosis and treatment are delayed, but the mortality rate is less than 10% in fairly well- compensated patients with early therapy. As many as 70% of patients who survive an episode of SBP have a recurrent episode within 1 year, and, for these patients, the mortality rate approaches 50%. Some studies suggest that the recurrence rate of SBP may be decreased to less than 20% with long-term antibiotic prophylaxis (eg, quinolones, trimethoprim-sulfamethoxazole); however, whether this improves long- term survival without liver transplantation is unclear. Secondary peritonitis and peritoneal abscess Treatment success of peritoneal infections is defined as adequate source control with resolution of sepsis and clearance of all residual intra-abdominal infection. With percutaneous treatment, the definition of success includes the avoidance of further operative intervention and, in some cases, the delay of surgery until after resolution of the initial sepsis. Over the past decade, the combination of better antibiotic therapy, more aggressive intensive care, and earlier diagnosis and therapy with a combination of operative and percutaneous techniques have led to a significant reduction in morbidity and mortality related to intra-abdominal sepsis. Uncomplicated SP and simple abscesses carry a mortality rate of less than 5%, but this rate may increase to greater than 30-50% in severe infections. The overall mortality rate related to intra-abdominal abscess formation is less than 10-20%. Factors that independently predict worse outcomes include advanced age, malnutrition, presence of cancer, a high APACHE II score on presentation, preoperative organ dysfunction, the presence of complex abscesses, and failure to improve in less than 24-72 hours after adequate therapy. In severe intra-abdominal infections and peritonitis, the mortality rate may increase to greater than 30-50%. The concurrent development of sepsis, SIRS, and MOF can increase the mortality rate to greater than 70%, and, in these patients, more than 80% of deaths occur with an active infection present.
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  • Winter '18
  • Jane doe
  • Sula, Peritoneum, peritoneal dialysis, Peritonitis

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