The goals of operative treatment of peritonitisI. to eliminate the source of contamination,II. to reduce the bacterial inoculum,III.to prevent recurrent or persistent sepsis
Begin broad-spectrum, systemic antibiotic therapy as soon as intra-abdominal infection is suspected. Correct existing serum electrolyte disturbances and coagulation abnormalities. Adequate analgesia with parenteral narcotic agents. Intubation and ventilator support
Laparatomy Intra and post operative drainage Decompression of small intestine
Gastric emptying. During the surgery probe should be in stomach all the time, during the preoperative period, and for some time afterwards. Before the resumption of intestinal motility.
Goal of the open-abdomen technique is to provide easy, direct access to the affected area. Done for initial damage control in extensive peritonitis. In patients who are at high risk for the development of abdominal compartment syndrome). Goal of the closed-abdomen technique is to provide definitive surgical treatment at the initial operation. Perform primary fascial closure and perform repeat laparotomy only when clinically indicated
Staging may be performed as a scheduled second-look operation or through open management, with or without temporary closure (eg, mesh, vacuum- assisted closure [VAC] technique). The goal of the initial operation is to provide preliminary drainage and to remove necrotic tissue. The patient is then resuscitated and stabilized in an intensive care unit (ICU) setting for 24-36 hours and returned to the operating room for more definitive drainage and source control. Eg. If bowel ischemia, the initial operation -remove all devitalized bowel. The second-look operation serves to reevaluate for further demarcation and decision-making regarding reanastomosis or diversion.
Temporary closure of the abdomen to prevent herniation and contamination from the outside of the abdominal contents by gauze and large, impermeable, self-adhesive membrane dressings; mesh (eg, Vicryl, Dexon); nonabsorbable mesh (eg, GORE-TEX, polypropylene), with or without zipper or Velcrolike closure devices; and VAC devices. Advantages : avoidance of abdominal compartment syndrome (ACS) and easy access for reexploration. Disadvantages : disruption of respiratory mechanics and contamination of the abdomen with nosocomial pathogens.
Washing reduces the microbial content in the exudate. Electrochemically activated solution of sodium chloride (0.05% sodium hypochlorite), it contains active chlorine and oxygen, furacillin and glucose solution 2.2% is used .
held probe correction enteric environment, including decompression, intestinal lavage, enterosorption and early enteral nutrition. This reduces the permeability of the intestinal barrier to microorganisms and toxins, leads to early recovery of functional activity of the updating the gastrointestinal tract.
2rubber tubes : One for antiseptic introduction. And other for active aspirated peritoneal fluid
monitor all patients closely in the appropriate clinical setting for adequacy of volume resuscitation, resolution or persistence of sepsis, and the development of organ system failure The patients overall condition should improve significantly and progressively within 24-72 hours of the initial treatment. All patients who are critically ill and patients receiving prolonged antibiotic therapy are at an increased risk for developing secondary, opportunistic infections (eg,Clostridium difficile colitis, fungal infections, central venous catheter infections, ventilator-associated pneumonia); monitor patients closely for signs and symptoms of these complications. Patients with severe abdominal infections demonstrate higher incidences of fascial dehiscence and incisional hernia development, requiring later reoperation.