2. The goals of operative treatment of peritonitis
I. to eliminate the source of contamination,
II. to reduce the bacterial inoculum,
III.to prevent recurrent or persistent sepsis
3. 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
4. Laparatomy
Intra and post operative drainage
Decompression of small intestine
5. 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.
6. 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
7. 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.
8. 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.[1]
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.
9. 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 .
10. 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.
11. 2rubber tubes :
One for antiseptic introduction.
And other for active aspirated peritoneal fluid
12. 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 patient's 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.
