Current and Future Concepts of Abdominal Sepsis

Abstract

Abdominal sepsis, intraabdominal infection, and peritonitis are often used synonymously. Some authors, however, differentiate between peritonitis as the localized equivalent of the systemic inflammatory response syndrome (SIRS) and intraabdominal infection as the localized equivalent of systemic sepsis [1, 2, 3, 4]. Peritonitis denotes intraabdominal infection caused by microbial pathogens or their products [4]. The clinical differentiation of these definitions is difficult in practice and consequently not particularly important for further diagnostic or therapeutic steps. It is important, however, to distinguish whether a patient is suffering from a local intraabdominal infection or an intraabdominal infection with a systemic reaction (abdominal sepsis). Many efforts have been made to classify peritonitis and, as a result, a variety of pathologic conditions have been described that range in severity from local problems to systemic complications [3, 5, 6, 7]. Complex classifications, however, lack transparency and lead to an imprecise gradation of peritonitis. Wittmann et al. presented a simplified scheme that is depicted in Table 1. It differentiates the relatively rare forms of primary and tertiary peritonitis from the more common secondary peritonitis for which surgical intervention is mandatory [4]. Clinical management of sepsis and peritonitis has been the subject of several recent reviews [4, 8, 9, 10, 11, 12, 13]. Table 1 Management of peritonitis. Kind of therapy Focal point Type of analysis References Conservative therapy Antiinflammatory Risk/efficacy of antiinflammatory agents Retrospective 8 Secondary peritonitis Review 4 ICU management Review 9 New concepts Immunology, standard + additive therapy Review 10 Operative therapy Laparotomy/relaparotomy open-abdomen management Secondary peritonitis Review 4 Operative management in ICU Review 9 Relaparotomy for secondary peritonitis Meta-analysis 11 Relaparotomy Report 12 Open-abdomen management Report 13 ICU: intensive care unit.