Generalized peritonitis. To irrigate or not to irrigate the abdominal cavity
J. L. Hunt
The objectives of surgery for generalized peritonitis are to eliminate the
source of continual bacterial contamination and to prevent septicemia and
intra-abdominal abscess formation. A prospective randomized study of three
different operative approaches of treating residual peritoneal
contamination was undertaken: group 1, no peritoneal irrigation (14
patients); group 2, intraoperative peritoneal irrigation (15 patients);
group 3, both intraoperative and postoperative peritoneal irrigation (15
patients). The mortality in groups 1, 2, and 3 was 28.5%, 26.6%, and 33%,
respectively. The overall incidence of septicemia and intra-abdominal
abscesses in groups 1, 2, and 3 was 23%, 22%, and 17%, respectively. In
those patients who survived, the incidence of intra-abdominal abscesses,
wound infection, and septicemia was 6%, 23%, and 13%, respectively. In this
series, there was no detectable difference in the mortality and infectious
complications between the three treatment groups. The only clinical factors
that adversely affected mortality and morbidity were peritonitis
originating from the colon and age greater than 60 years. Early surgical
intervention with removal of the source of peritonitis, debridement of all
necrotic tissue, and drainage of abscesses remain the cornerstones of
successful therapy in generalized peritonitis.
