Acute diffused purulent peritonitis: conceptual aspects of the modern surgical tactics

Abstract

Objective. To accentuate an attention on conceptual aspects of surgical treatment of patients on acute purulent diffused peritonitis (APDP).
 Materials and methods. Were treated a 371 patients on APDP in age from 18 to 87 years; males – 207 (56 %), females – 164 (44 %). In structure of factors of peritonitis development predominated an acute destructive appendicitis (23 %), perforated ulcer of pyloroduodenal part of the stomach (21 %), acute pancreatitis / purulent-necrotic pancreonecrosis (18 %), acute destructive cholecystitis (14 %).
 Results and discussion. Carried out analysis allowed to determine the next conceptual aspects of the problem. In particular, according to recommendations of the World Society of Emergency Surgery (WSES, 2016), APDP necessary to interpret as “complicated intraabdominal infection” with evaluation of clinical state of patient, localization of source of infection, its spreading, availability of the multiorgan insufficiency, characteristics of bacterial pathogens and their antibacterial sensitivity. Is appropriate an usage of the single classification of degree of peritonitis spreading with terminological definition its as “local”, “diffused” and “total”. Helping carried out a bacterial investigations were revealed domination of aerobic bacteria as monoculture (37 %) and aerobic-anaerobic associations (39 %) with gram-negative sign (56 %) and species composition as enterobacteria and anaerobic nonclostridial microbs. The initial antibiotic therapy induces the high level of polyresistance of flora, that causes necessarily of permanent determination of bacteria sensitivity to antibiotics and timely change of regimens their administration. Operational intervention, excepting a control of the source of infection, must to foresee a measures of correction of appeared pathologic intraabdominal syndromes, in particular compartment-syndrome, enteral insufficiency and redundant contamination of digestive tract by microflora of the large intestine. The very important compound of treatment is full-fledged infusion therapy. Relaparotomy represents an effective instrument with performing its for regulated clearly indications.
 Conclusions. Realization of the outlined medical tactics compaunds will promote to the rise of efficiency of ADPP treatment.