Contributing factors of peritoneal infection in closed incisions of abdomen

Abstract

1. 1. Absolute asepsis being only a dream, the presence of low grade bacteria in the peritoneum cannot be ignored in a study of the causes of the initial development of adhesions and the so-called aseptic peritonitis. 2. 2. Clinical observations seem to corroborate the theory that in closed incisions there is a causative relation between low grade bacteria and the more active type of infections in promoting virulence through synergy and symbiosis and that further research studies should rationalize the process. 3. 3. The fate of low grade infections is determined within the incubation period of the first three or four days yet not in evidence until later, possibly leading secondarily to active infection, or else extensive adhesions. 4. 4. Every abdominal section is followed by an increased effusion of serum with a wider diffusion and requires a certain degree of physiological attenuation for resorption. 5. 5. Mechanically harmless tissue tubes will drain wider spaces before the stage of plastic exudates. 6. 6. A proper postoperative regime more or less negative in character will safeguard to a great extent these remarkable conservative processes of the peritoneum unless already overtaxed. 7. 7. The contributing factors of infection are surgical trauma, incomplete hemostasis, dead spaces, tension, tympany, trauma from peristalsis and vomiting, restlessness, infection from the stump of the appendix, etc. 8. 8. In view of the necessity of long range viewpoints the ambition for individualizing the postoperative treatment of the average case of closed incision will not lead to any reliable conclusions as to the mitigation of infections in general and is a menace to an efficient nursing regime; for preventive measures require to be standardized and more or less routine in their application and when a greater number of deaths in any large number of cases occur in closed incisions for appendicitis than result from grossly infected types a serious reckoning should be undertaken. 9. 9. The oft repeated statement that the fate of the patient is sealed when the incision is closed should be protested.