History of the procedure untreated acute peritonitis

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History of the Procedure Untreated, acute peritonitis may be fatal. The fundamental role of operative therapy in the treatment of peritonitis was documented in 1926 when Kirschner reported that the mortality rate from intra-abdominal infections decreased from more than 90% to less than 40% during the period from 1890-1924 with the introduction of operative management. Other elements, such as advances in the understanding of damage control surgery, novel antibiotics, and improvements in intensive care unit (ICU) treatment have now reduced mortality to approximately 20%. The current approach to peritonitis and peritoneal abscesses targets correction of the underlying process, administration of systemic antibiotics, and supportive therapy to prevent or limit secondary complications due to organ system failure. Frequency The overall incidence of peritoneal infection and abscess is difficult to establish and varies with the underlying abdominal disease processes. The most common etiology of primary peritonitis is spontaneous bacterial peritonitis (SBP) caused by chronic liver disease. Up to 30% of all patients with liver cirrhosis with ascites develop SBP. 5
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The common etiologic entities of secondary peritonitis (SP) include perforated appendicitis ; perforated gastric or duodenal ulcer ; perforated (sigmoid) colon caused by diverticulitis , volvulus , or cancer ; and strangulation of the small bowel (see Table 1). Necrotizing pancreatitis can also be associated with peritonitis in the case of infection of the necrotic tissue. SP also occurs, albeit infrequently, in patients with cirrhosis. In a retrospective analysis, Soriano et al compared the clinical characteristics and prognosis of SP with SBP in cirrhotic patients (24 patients with SP vs 106 episodes of SBP). The authors found that SP accounted for 4.5% of peritonitis cases in the study's cirrhotic patients. They also determined that in patients whose SP had been confirmed by surgery or autopsy, the diagnostic sensitivity and specificity of Runyon's criteria was 66.6% and 89.7%, respectively, with Runyon's criteria and/or polymicrobial ascitic fluid culture found in 95.6% of the patients. Abdominal computed tomography (CT) scanning was diagnostic in 85% of these patients. The local inflammatory response in the study's patients with SP was significantly more severe than it was in patients with SBP, and the mortality rate during hospitalization was higher for SP than for SBP patients (66% vs 26.4%, respectively). However, patients with SP who underwent surgical treatment tended to have a lower mortality rate than did those who received only medical therapy (53.8% vs 81.8%, respectively). Among the surgically treated patients with SP, the survival rate was greater in those with the shortest time between diagnostic paracentesis and surgery (3.2+/-2.4 days in survivors vs 7.2+/-6.1 days in nonsurvivors, p=0.31). Soriano and colleagues concluded that the prognosis of cirrhotic patients with SP could be improved via a low threshold of suspicion on the basis of Runyon's criteria and
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  • Winter '18
  • Jane doe
  • Sula, Peritoneum, peritoneal dialysis, Peritonitis

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