Severity Of Peritonitis Research Articles

#1513 Update on the peritonitis trend in central Spain

Abstract Background and Aims Peritonitis is one of the most common and severe complications associated with peritoneal dialysis (PD) traditionally cited as the primary cause of catheter loss and discontinuation of the dialysis technique. Nevertheless, the incidence and severity of peritonitis has been significantly reduced over time. Therefore, we aimed to update the current impact of peritonitis in PD patients. Method We performed an observational, multi-centre, prospective cohort including 3,037 patients who started PD between 2003-2020 followed for a median of 1.6 [0.8-2.9] years. Results We observed 2 941 episodes of peritonitis, with a peritonitis rate (PR) of 0.46 episodes per patient year and a mean of 2.6 years CI 95% [2.4-2.8] to first peritonitis episode. As expected, gram-positive organism was identified in the 69.3% of the cases, followed by gram-negative (19.6%) and sterile culture (15.6%). The usual course of the peritonitis is favourable, with complete recovery in the 76.4% of the cases, whereas just the 37.6% require admission during a median of 5 [3-9] days, with a peritonitis recurrence of 11.2%. A fatal peritonitis (resulted in PD cessation) was observed in 11.7% of the patients with an overall mortality of 0.7% (considering all the deaths within the 90 days after peritonitis). Factors associated with a 90-days mortality rate related to PD rate were age > 65 years (OR 2.99 [1.84-4.85]), Charlson index (OR 1.19 [1.07-1.33]), and the type of microorganism: fungus (OR 9.8 [4.16-23.43], multi-bacterial (OR 7.97 [0.91-69.88] and gram- negative OR (2.41 [1.45, 3.99]). Comparing patients who developed peritonitis (P) (N = 1230) vs patients who not developed peritonitis (NP) (N = 1807), P patients were older (P 59 ± 15.5 years vs NP 55 ± 15.5 years, p < 0.001) and associated higher comorbidity (such as Charlson index, cardiovascular and diabetes mellitus history) than NP patients. P patients more commonly had a prior history of renal replacement therapy (kidney transplant P 9.2% vs NP 6.9% and hemodialysis 18.8% vs 17.1%) compared with NP patients. PR has significantly decreased over three consecutive 5-year periods: from 0.51 [0.48-0.54] peritonitis cases per year during 2003-2008 to 0.45 [0.43-0.48] during 2009-2014 (p 0.03), and further dropping to 0.41 [0.38-0.44] for the period 2015-2020 (p < 0.001). Conclusion Over the past 17 years, the incidence and severity of peritonitis have significantly reduced, despite PD patients becoming older and associated high comorbidities.

IMMEDIATE RESULTS OF MINIMALLY INVASIVE SURGERY FOR COMPLICATED PEPTIC ULCERS OF THE STOMACH AND DUODENUM

Objective: To enhance the immediate treatment outcomes of complicated peptic ulcers of the stomach and duodenum through the development and application of video-assisted organ-preserving surgeries. Materials and Methods: This study analyzed the treatment outcomes of 261 patients with complicated gastric and duodenal ulcers. The patients received the treatment in the surgical departments of Azerbaijan State Advanced Training Institute for Doctors named after A. Aliyev, Scientific Surgical Center named after M.A. Topchubashev, and Sabunchi Medical Center from 2015 to 2023. All patients with perforated and bleeding ulcers of the stomach and duodenum underwent clinical and instrumental examinations. The initial general condition of the patient was thoroughly assessed. Among the patients, there were 220 men (84.3%) and 41 women (15.7%), with ages ranging from 18 to 84 years. There were 75 (28.7%) patients complicated with bleeding of gastric and duodenal ulcer, and 186 (71.3%) patients with perforation. In the control group, traditional, "open" surgical interventions were performed in 164 (62.8%) patients, and minimally invasive endoscopic video-assisted operations were performed in 97 (37.2%) cases. Out of 186 patients, 124 (66.7%) underwent traditional suturing of a perforated gastroduodenal ulcer during laparotomy, while 62 (33.3%) underwent minimally invasive endosurgical interventions. In the control group, 12 (8.4%) patients underwent gastric resection, and 10 (5.4%) underwent vagotomy with pyloroplasty. The immediate results of radical operations for a perforated ulcer were characterized by a high percentage of early complications, with 5 (41.6%) cases. Results. Of the 186 patients operated on for perforated gastroduodenal ulcer, 12 individuals (6.5±2.9%) developed complications in the postoperative period: 9 (7.3%) in the comparison group, and 3 (4.8%) patients in the main group. We obtained a statistically significant shorter duration of a surgical intervention by 24.8 minutes and shorter hospital staying time due to a decrease in the duration of the postoperative period by 5.3 days, a lower number of postoperative complications by 2.5%, and a lower postoperative mortality by 2.4%. The duration of laparoscopic suturing of a perforated ulcer averaged 38.6 minutes. The duration of hospital staying averaged 6.9±1.2 days. The use of minimally invasive interventions for ulcerative duodenal bleeding was accompanied by a significant reduction in the rehabilitation period compared with that after traditional, "open" operations that amounted to 18.3+3.6 and 35.5±5.9 days, respectively. Postoperative mortality was 1.3% (1 patient in the control group died). Conclusion. The outcome of treatment depends on the age of patients, the timing of the onset of the disease, the severity of concomitant pathology, the severity and extent of peritonitis and the duration of ulcerative anamnesis.

Predictive Role of Acute Physiology and Chronic Health Evaluation II (APACHE II) in Patients With Peritonitis at the National Hospital Abuja.

A validated tool may facilitate assessing the severity of peritonitis among surgical patients. This study evaluates the predictive role of Acute Physiology and Chronic Health Evaluation II (APACHE II) in the surgical outcomes of patients managed for peritonitis in Abuja. This is a prospective study of consecutive adult patients managed for peritonitis by the general surgery unit of National Hospital Abuja (NHA) over a 19-month period (September 2020 through March 2022). Patient characteristics and treatment outcomes were recorded in a structured proforma and analyzed using SPSS Statistics version 25 (IBM Corp., Released 2017; IBM SPSS Statistics for Windows, Version 25.0; Armonk, NY: IBM Corp.). The accuracy, sensitivity, specificity, and threshold of APACHE II were derived from the receiver operating characteristic (ROC) curve analysis and its coordinates. There were 54 patients with peritonitis during the study period, with a male-to-female ratio of 2.6:1. This study's mortality and morbidity rates were 13.0% and 63.0%, respectively. The APACHE II score at admission was positively correlated with the likelihood of postoperative mortality, morbidity, number of postoperative complications, ICU admission, and length of hospital admission. The average APACHE II score of patients in this study was 7.1±5.2. APACHE II best-predicted mortality by the ROC curve at a threshold point of 9 (sensitivity of 85.7%, specificity of 70.2%, the accuracy of 86.8%, P-value 0.002). At a threshold score of 6, APACHE II was significantly associated with the occurrence of postoperative morbidity (sensitivity of 74.3%, specificity of 73.7%, accuracy of 75.2%, P-value = 0.043). This study confirms that the APACHE II score at admission can predict the outcome of surgery within the first 30 days post-surgery among adult patients who had peritonitis at NHA.

The influence of preoperative e intraoperative factors in predicting postoperative morbidity and mortality in perforated diverticulitis: a systematic review and meta-analysis.

To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and severity of peritonitis affect the rate of morbidity and mortality in patients undergoing a primary anastomosis (PA) or Hartmann Procedure (HP) for perforated diverticulitis.This is a systematic review and meta-analysis, conducted according to PRISMA, with an electronic search of the PubMed, Medline, Cochrane Library, and Google Scholar databases. The search retrieved 614 studies, of which 11 were included. Preoperative-Intraoperative factors including age, ASA classification, BMI, severity of peritonitis, and comorbidities were collected.Primary endpoints were mortality and postoperative complications including sepsis, surgical site infection, wound dehiscence, hemorrhage, postoperative ileus, stoma complications, anastomotic leak, and stump leakage. 133,304 patients were included, of whom 126,504 (94.9%) underwent a HP and 6800 (5.1%) underwent a PA. There was no difference between the groups with regards to comorbidities (p = 0.32), BMI (p = 0.28), or severity of peritonitis (p = 0.09). There was no difference in mortality [RR 0.76 (0.44-1.33); p = 0.33]; [RR 0.66 (0.33-1.35); p = 0.25]. More non-surgical postoperative complications occurred in the HP group (p = 0.02). There was a significant association in the HP group between the severity of peritonitis and mortality (p = 0.01), and surgical site infection (p = 0.01). In patients with perforated diverticulitis, PA can be chosen. Age, comorbidities, and BMI do not influence postoperative outcomes. The severity of peritonitis should be taken into account as a predictor of postoperative morbidity and mortality.

The association of TLR4 gene polymorphisms with the severity of peritonitis in acute inflammatory diseases of the abdominal cavity organs.

Aim: To determine the role of TLR4 gene polymorphisms as risk factors for peritonitis severity in patients undergoing surgery for acute inflammatory diseases of the abdominal cavity. Materials and Methods: The study included 139 patients who were operated on for acute abdominal diseases (acute appendicitis and cholecystitis, perforated gastric or duodenal ulcer, etc.). Depending on the number of points on the modified APACHE II scale, patients were divided into two groups: Group 1 - 1-3 points (63 patients, 45.3%) and Group 2 - 4 or more points (76 patients, 54.7%). Polymorphisms rs1927911, rs2149356 and rs4986790 were determined by polymerase chain reaction. Results: The rs1927911 polymorphism of the TLR4 gene was protective for the development of peritonitis (according to the allelic model, OR 0.48; 95% CI 0.27-0.84; p=0.015). Regression analysis revealed a reduced (p=0.015) risk of severe peritonitis in rs1927911 A/A or G/A genotype carriers (OR 0.42; 95% CI 0.21-0.84) compared with G/G genotype carriers. There was no effect on the severity of peritonitis of TLR4 polymorphisms rs2149356 and rs4986790. There was a tendency to increase the frequency of the mutant G rs4986790 allele in patients with severe peritonitis (χ2=2.17; p<0.001). The analysis of the association of TLR4 gene polymorphisms with the phenotype of patients showed that carriers of mutant homozygotes and heterozygotes in the presence of severe peritonitis were older, had a tendency to coagulopathy, higher leukocytosis and leukocyte clotting rate. Conclusions: Thus, the importance of TLR in the development of severe peritonitis was confirmed and the protective role of the rs1927911 promoter polymorphism was established.

Effect of Different Methods of Abdominal Decompression on the Dynamics of Intra-Abdominal Pressure in the Early Postoperative Period in Patients with Secondary Diffuse Peritonitis: Observational Study

Background. Intra-abdominal hypertension complicates the course of secondary diffuse peritonitis in at least 60–70% of cases. Abdominal decompression is an essential component in the complex of therapeutic measures in patients with secondary diffuse peritonitis. However, no clear criteria for choosing the method and timing of abdominal decompression have been developed so far. The effectiveness of its use in various forms of peritonitis remains controversial.Objectives — to study the dynamics of intra-abdominal pressure in the early postoperative period when using various methods of abdominal decompression in patients with secondary diffuse peritonitis.Methods. The work was performed on the basis of an observational clinical study under the auspices of Regional Clinical Emergency Hospital over a period from January 2021 to December 2022. The authors studied intra-abdominal pressure in 74 patients with secondary diffuse peritonitis in the early postoperative period. In 39 (52.7%) patients (group 1), decompression was carried out in the form of prolonged nasogastric intubation. 15 (20.3%) patients (group 2) underwent nasointestinal intubation. Group 3 was represented by 10 patients (13.5%) which were affected by open abdomen technology and vacuum assisted closure (VAC). Group 4 included patients with vacuum-assisted laparostoma who underwent nasointestinal intubation. The severity of peritonitis was assessed using WSES cIAIs Score and Mannheim Peritonitis Index. The dynamics of intra-abdominal pressure was determined through the urinary catheter using the Uno Meter Abdo Pressure® Kit (Unomedical, Russia) before surgery and within 5 days of the postoperative period. Statistical analysis was based on non-parametric Wilcoxon test for comparing the values of the same group at different periods of observation. Mann-Whitney U-test was used to compare absolute values in different groups.Results. Nasogastric tube did not provide an acceptable reduction in intra-abdominal pressure, especially in patients with severe forms of peritonitis. Prolonged nasointestinal intubation contributed to a steady decrease in intra-abdominal pressure throughout the postoperative period, while simultaneous intubation resulted in an increase in intra-abdominal hypertension after a decline in values one day after surgery. The best results of intra-abdominal pressure dynamics were observed in case of vacuum-assisted laparostomy and its combination with nasointestinal intubation. Throughout the postoperative period, the intra-abdominal pressure did not exceed 15–17 mmHg. This method can be used only in treatment of the most severe forms of peritonitis, with indications for sanitation relaparotomy and in case of threatened abdominal compression syndrome.Conclusion. The data obtained enable the process of choosing surgical tactics and method of abdominal decompression to be optimized with respect to the severity of peritonitis and intra-abdominal hypertension.

Primary intestinal anastomosis in a child with perforation of Meckel’s diverticulum and peritonitis

This paper presents the treatment course of a 13-year-old child with Meckels gangrenous-perforative diverticulitis complicated by diffuse peritonitis. The perforation was localized at the base of Meckels diverticulum; therefore, ileal resection was performed. Peritonitis required a difficult choice of further surgical management, i.e., stoma formation or primary intestinal anastomosis. Nowadays, an enterostomy is considered the most reliable and rational surgical option after bowel resection in peritonitis conditions. However, this issue has become increasingly controversial. Many studies have confirmed the success of primary intestinal anastomosis, regardless of the severity of peritonitis and degree of contamination of the abdominal cavity, even noting the advantages of radical treatment and prevention of various stoma-related complications. In the presented clinical case, the child underwent primary intestinal anastomosis despite the exudative inflammatory process in the abdominal cavity. This option was chosen because of the stable general condition of the child, satisfactory central and peripheral hemodynamics, and absence of significant hydrobalance disorders. No complications occurred during the postoperative period. The child was discharged on postoperative day 7. In this study, we aimed to evaluate our experience with the primary anastomosis approach in peritonitis.

Bat ASC2 suppresses inflammasomes and ameliorates inflammatory diseases

Bats are special in their ability to live long and host many emerging viruses. Our previous studies showed that bats have altered inflammasomes, which are central players in aging and infection. However, the role of inflammasome signaling in combating inflammatory diseases remains poorly understood. Here, we report bat ASC2 as a potent negative regulator of inflammasomes. Bat ASC2 is highly expressed at both the mRNA and protein levels and is highly potent in inhibiting human and mouse inflammasomes. Transgenic expression of bat ASC2 in mice reduced the severity of peritonitis induced by gout crystals and ASC particles. Bat ASC2 also dampened inflammation induced by multiple viruses and reduced mortality of influenza A virus infection. Importantly, it also suppressed SARS-CoV-2-immune-complex-induced inflammasome activation. Four key residues were identified for the gain of function of bat ASC2. Our results demonstrate that bat ASC2 is an important negative regulator of inflammasomes with therapeutic potential in inflammatory diseases.

Assessment of severity of peritonitis due to hollow viscous perforation- using APACHE II score

: Acute widespread peritonitis caused by a perforated hollow viscus is a potentially fatal illness. It's a common surgical emergency in many developing-country general surgical departments, and it's often associated with substantial morbidity and mortality. Grading the severity of acute peritonitis has greatly aided decision-making and improved the therapeutic success in the management of critically ill patients. Empirically based risk assessment for major clinical events has proven to be tremendously valuable in evaluating new medicines, monitoring resource utilisation, and improving care quality. A hospital based prospective observational study was conducted on patients operated on emergency basis for hollow viscus perforation admitted to the hospital, the study was conducted from OCT 2014 – SEP 2016 at Kamineni institute Medical sciences &amp; hospital, Narketpally, Telengana. A series of 100 cases was compiled for this study during this period. The accuracy in outcome prediction of APACHE–II system was assessed by means of receiver operating characteristic curve and Pearson correlation coefficient. The Analytical data obtained was compared and discussed with the data available in the literature. A total of 100 patients were studied. Out of which there were 86(86%) survivors and 14(14%) non-survivors. Mean APACHE–II score of the study population was 9.80 with a range of 1-30. The predicted death rate for the study population was 16% and observed death rate was 14%. Mean APACHE–II score in survivors was 8.03 where as in non-survivors it was 20.64. The area under the curve using receiver operating characteristic curve analysis was found to be 0.985. The association between the APACHE-II score and the predicted death rate was flawless, with r = 0.99 and P0.001. In patients with peritonitis caused by hollow viscus perforation, an APACHE-II score of 11-20 was found to be a stronger predictor of mortality risk. In patient groups with APACHE-II scores of 0-10 and scores &amp;#62; 20, predicted death did not match observed mortality. APACHI-II scoring system can be used for assessment of group out come in patients with peritonitis due to hollow viscus perforation. However, it does not provide sufficient confidence for outcome prediction in individual patient.

Akkermansia muciniphila Reduces Peritonitis and Improves Intestinal Tissue Wound Healing after a Colonic Transmural Defect by a MyD88-Dependent Mechanism.

Anastomotic leakage is a major complication following colorectal surgery leading to peritonitis, complications, and mortality. Akkermansia muciniphila has shown beneficial effects on the gut barrier function. Whether A. muciniphila reduces peritonitis and mortality during colonic leakage is unknown. Whether A. muciniphila can directly modulate the expression of genes in the colonic mucosa in humans has never been studied. We investigated the effects of a pretreatment (14 days) with live A. muciniphila prior to surgical colonic perforation on peritonitis, mortality, and wound healing. We used mice with an inducible intestinal-epithelial-cell-specific deletion of MyD88 (IEC-MyD88 KO) to investigate the role of the innate immune system in this context. In a proof-of-concept pilot study, healthy humans were exposed to A. muciniphila for 2 h and colonic biopsies taken before and after colonic instillation for transcriptomic analysis. Seven days after colonic perforation, A.-muciniphila-treated mice had significantly lower mortality and severity of peritonitis. This effect was associated with significant improvements of wound histological healing scores, higher production of IL22, but no changes in the mucus layer thickness or genes involved in cell renewal, proliferation, or differentiation. All these effects were abolished in IEC-MyD88 KO mice. Finally, human subjects exposed to A. muciniphila exhibited an increased level of the bacterium at the mucus level 2 h after instillation and significant changes in the expression of different genes involved in the regulation of cell cycling, gene transcription, immunity, and inflammation in their colonic mucosa. A. muciniphila improves wound healing during transmural colonic wall defect through mechanisms possibly involving IL22 signaling and requiring MyD88 in the intestinal cells. In healthy humans, colonic administration of A. muciniphila is well tolerated and changes the expression of genes involved in the immune pathways.

Application of Damage Control tactics in the treatment of patients with generalized peritonitis and septic shock

INTRODUCTION. Patients with peritonitis complicated by severe sepsis and septic shock determine the mortality rate of a general surgical hospital. The role and place of the Damage control technique in this category of patients remain debatable.The OBJECTIVE was to analyze the use of tactics of staged surgical treatment in patients with peritonitis and septic shock.METHODS AND MATERIALS. On the base of the Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, we conducted a prospective randomized study of the effectiveness of various approaches to the treatment of patients with non-traumatic peritonitis and septic shock, who, after elimination of the primary source, need to restore intestinal continuity. The study included 37 patients, their mean age was (69±14) years, women were 19 (51 %). The patients were divided into 2 groups: the study group (n=14) included patients treated with the Damage Control (DC) principle, in the comparison group (n=23), primary surgery was performed in full. Both groups are representative in terms of demographics, comorbidity, severity of peritonitis and organ dysfunction.RESULTS. The groups differed significantly in the duration of preoperative preparation (p=0.028) and surgery (p=0.025). Mortality rate among patients who used DC tactics was 2 times lower (35.6 vs. 73.9 %) (p=0.038). When assessing the indicators of systemic hypoperfusion, a difference was noted in the dynamics of lactate (p=0.048) and INR (p=0.007) values during the first three days of the postoperative period. Accordingly, in patients who underwent staged treatment, there was a positive dynamics in SOFA values (p=0.049) from the 3rd day, and by the 7th day of the postoperative period in most patients, this indicator did not exceed 2 points (p=0.048). During staged surgical treatment, a constant increase in the Horvitz index was recorded from the second day of the postoperative period, while in the control group, the dynamics of this indicator was negative (p=0.041).СONCLUSIONS. Damage control tactics is safe and can be used in the treatment of general surgical patients with non-traumatic peritonitis and septic shock. Reducing the duration of preoperative preparation, reducing the volume of surgical intervention and, consequently, the duration of the operation allow reduce the time for eliminating signs of systemic hypoperfusion and organ dysfunction, which reduces the rate of death.

Study of Factors Involved in Perforative Peritonitis and Its Significance to Mortality and Morbidity

Background: Peritonitis caused by gastrointestinal perforation is one of the most prevalent surgical emergencies worldwide. Early detection and treatment of Perforation Peritonitis may significantly minimize morbidity and death. The result is improved by surgical treatment and good perioperative care. The purpose of this clinical trial is to assess the outcome of perforation peritonitis. Hence the present study was conducted at a tertiary healthcare institute to study factors involved in perforative peritonitis and its significance to mortality and morbidity.&#x0D; Materials and Methods: It was a Prospective Observational Study, conducted over a period of 18 months at the department of General Surgery, KIMSDU, Karad, among the patients presenting in emergency room of Krishna Institute of Medical Sciences and Research Centre, Karad, between any age group, with symptoms of acute pain in abdomen with gas under diaphragm seen on either chest radiograph or x-ray erect abdomen.&#x0D; Results: In the present study we assessed the Operative procedures among the study subjects. We observed that open appendectomy was performed among 23.08% study subjects, open perforation closure was performed among 26.92% study subjects, resection and anastomosis was performed among 8.46% study subjects, resection anastomosis and Stomy was performed among 6.92% study subjects, simple closure was performed among 34.62% study subjects.&#x0D; Conclusions: All the MPI parameters: extension of peritonitis, presence of organ failure, time of presentation, type of exudates, presence of malignancy, age, found to be associated with severity of peritonitis.

Severe secondary peritonitis: impact of inappropriate initial antimicrobial therapy on prognosis and potential carbapenem-sparing.

Initiation of antimicrobial therapy (IAT) with broad-spectrum antibiotics is usual in Intensive Care Unit (ICU) patients with secondary peritonitis. Carbapenems are widely proposed by recent guidelines contrasting with current antibiotic stewardship policies of carbapenem-sparing. However, prognosis of inappropriate IAT remains unclear in these patients and broad-spectrum antibiotics are probably overused. We aimed to assess the role of inappropriate IAT in ICU patients with secondary peritonitis and the use of carbapenems in our IAT regimens. We performed a retrospective analysis during a six-year period including 131 ICU patients with secondary peritonitis. We collected data concerning comorbidities, source and severity of peritonitis, management of IAT, peritoneal samples and outcome. Forty-one patients presented with community acquired peritonitis (CAP) and 90 with postoperative peritonitis (POP). Thirty-seven (28.2%) patients died during ICU stay. IAT was inappropriate in 35 (26.7%) patients. Inappropriate IAT was not associated with reduced survival with respectively 26 (27%) deaths when IAT was adequate and 11 (31.4%) deaths when IAT was inadequate (P=0.87). Inappropriate IAT was not associated with the need of re-operation and duration of ICU stay. Carbapenems were delivered in 29 patients but were only necessary for eight patients without alternative treatment. In our study, inappropriate IAT was not associated with a worse prognosis and carbapenems were overused. Extensive delivery of carbapenems proposed by recent guidelines could be reconsidered in the management of these patients.

Management of gastrojejunostomy anastomotic leak post one anastomosis gastric bypass with a covered stent alone

Leaks after one anastomosis gastric bypass are managed based on the timing of presentation and the presence or absence of peritonitis. Reoperation is strongly advocated because of the potential severity of biliary peritonitis. Recently, nonoperative treatment is being increasingly employed, especially for staple line disruptions or unspecified leaks. We report successful usage of a covered esophageal stent in a gastrojejunostomy anastomosis leak with a favorable outcome.

Methodology for assessing the severity of diffuse peritonitis and prognosis of relaparotomy

INTRODUCTION. The problem of treating patients with peritonitis has always been and still remains relevant in surgery. Moreover, aspects of treating patients with tertiary peritonitis requiring repeated interventions are of particular importance. The OBJECTIVE of this work was to develop and evaluate the clinical effectiveness of a score-prognostic scale that allows to identify groups of patients with a high risk of persistent surgical infection in the abdominal cavity, in which a single intervention cannot be considered effective even despite the elimination of the primary surgical infection focus.METHODS AND MATERIALS. To achieve the goal, a correlation was evaluated between a number of factors and the likelihood of relaparotomy in a retrospective group consisting of 111 patients with secondary peritonitis. Based on the achieved data, score-prognostic scale for assessing the severity of peritonitis was developed, which allowed to formulate an algorithm of surgical tactics, which was used in the treatment of 109 patients. A group of 34 people with a high risk of tertiary peritonitis development was allocated from the number of patients – of which 20 patients had a total number of 39 planned surgical interventions.RESULTS. The use of the developed scale led to an increase in the total number of surgical interventions, however, reducing postoperative mortality by 1.7 times (p = 0.001) mainly due to improved survival rates in the group of patients with severe forms of peritonitis.CONCLUSION. The obtained results allowed to recommend the developed integral prognostic scale for assessing the severity of peritonitis for use in clinical practice.

Modern view in diagnosis of uremic pseudoperitonitis and peritonitis in patients on renal replacement therapy (programmed hemodialysis)

Objective. Determination of blood serum 2-microglobulin and lactoferrin concentration in patients on renal replacement therapy (programmed hemodialysis) for the diagnosis of uremic pseudoperitonitis and peritonitis. Materials and methods. We examined 56 patients admitted to the Surgical Department of Astrakhan Clinical Hospital RZhD-Medicine and City Clinical Hospital № 3, and studied the concentration of blood serum 2-microglobulin and lactoferrin in patients urgently hospitalized with suspicion of uremic pseudoperitonitis or peritonitis, who receive renal replacement therapy (programmed hemodialysis). The control group included 50 outpatients on renal replacement therapy (programmed hemodialysis). The study did not include patients with suspected peritonitis who did not receive renal replacement therapy (programmed hemodialysis). The period of the study is 20192021. Results. The concentration of serum 2-microglobulin is statistically higher than normal in all patients receiving renal replacement therapy (programmed hemodialysis) in anamnesis. The most statistically high concentration of 2-microglobulin was detected in patients with uremic pseudoperitonitis (n = 39), and was 30000 6680 ng/ml compared with the concentration in the blood serum among patients with peritonitis 6000 519.9 ng/ml. The concentration of lactoferrin is statistically high in peritonitis (n = 17) and was 3480 439 ng/ml compared with uremic pseudoperitonitis 1160 148 ng/ml. In the control group of outpatients (n = 50), who received renal replacement therapy (programmed hemodialysis), no statistically significant concentrations of blood serum 2-microglobulin and lactoferrin were detected. Conclusions. A clear dependence of 2-microglobulin and lactoferrin concentrations on the severity of uremic pseudoperitonitis and peritonitis was established. Statistically high values of 2-microglobulin concentration were obtained in patients with uremic pseudoperitonitis, and the level of lactoferrin was statistically high in peritonitis.

Outcome in patients with open abdomen treatment for peritonitis: a multidomain approach outperforms single domain predictions

Numerous patient-related clinical parameters and treatment-specific variables have been identified as causing or contributing to the severity of peritonitis. We postulated that a combination of clinical and surgical markers and scoring systems would outperform each of these predictors in isolation. To investigate this hypothesis, we developed a multivariable model to examine whether survival outcome can reliably be predicted in peritonitis patients treated with open abdomen. This single-center retrospective analysis used univariable and multivariable logistic regression modeling in combination with repeated random sub-sampling validation to examine the predictive capabilities of domain-specific predictors (i.e., demography, physiology, surgery). We analyzed data of 1,351 consecutive adult patients (55.7% male) who underwent open abdominal surgery in the study period (January 1998 to December 2018). Core variables included demographics, clinical scores, surgical indices and indicators of organ dysfunction, peritonitis index, incision type, fascia closure, wound healing, and fascial dehiscence. Postoperative complications were also added when available. A multidomain peritonitis prediction model (MPPM) was constructed to bridge the mortality predictions from individual domains (demographic, physiological and surgical). The MPPM is based on data of n = 597 patients, features high predictive capabilities (area under the receiver operating curve: 0.87 (0.85 to 0.90, 95% CI)) and is well calibrated. The surgical predictor “skin closure” was found to be the most important predictor of survival in our cohort, closely followed by the two physiological predictors SAPS-II and MPI. Marginal effects plots highlight the effect of individual outcomes on the prediction of survival outcome in patients undergoing staged laparotomies for treatment of peritonitis. Although most single indices exhibited moderate performance, we observed that the predictive performance was markedly increased when an integrative prediction model was applied. Our proposed MPPM integrative prediction model may outperform the predictive power of current models.

EFFICACY OF MANNHEIM PERITONITIS INDEX IN PREDICTION OF MORTALITY AND MORBIDITY IN PATIENTS WITH SECONDARY PERITONITIS

Background: Acute generalized peritonitis following hollow viscus perforation is a potentially life threatening condition leading to a cascade of infective processes, sepsis, disseminated intravascular coagulation, multi organ failure and death in the presence of irreversible damage to the vital organs. Grading the severity of acute peritonitis can contribute in better management of patients with perforation peritonitis. The Mannheim Peritonitis Index (MPI) scoring system takes into account various characteristics like age of the patient, gender, duration of peritonitis, organ failure, Malignancy, colonic sepsis, extent of spread and character of the peritoneal uid. The Objective of this study was to determine the Prognostic value of MPI in patients with Secondary Peritonitis. Methods: In this study conducted at SMI Hospital, Dehradun, Over a period of 1 year, all patients presenting with features of Peritonitis due to hollow viscus perforation were included. MPI score of all the patients were calculated and categorized into three groups; less than 21, 21-29 and more than 29. Mortality of patients from each group was calculated and predictive value of each factor was determined. Results:Total 150 patients were included in this study. There were total 21 mortalities. For patients with a score &lt;21, the mortality rate was 0%; for score 21–29, it was 4.3%; and for score &gt;27, it was 67.9% (P &lt; 0.001). Age&gt; 50 years, presence of organ failure, malignancy, presentation after 24 hours, generalized peritonitis and Fecal exudate were associated with higher mortality rates. Conclusions: MPI is a simple and useful scoring system to determine the prognosis and complications in patients with perforation peritonitis.

ENTERAL INSUFFICIENCY COURSE SEVERITY DEGREES DIAGNOSTICS IN PERITONITIS BY SMALL INTESTINAL MICROSCOPIC IMAGES PHASE MAPING

Summary. The aim is to determine the efficiency of diagnostics of the enteric insufficiency syndrome severity in peritonitis by phase mapping of microscopic images of histological sections of the laboratory rats’ small intestine.&#x0D; Material and methods. Seventy-eight white nonlinear rats of both sexes were selected, weighing from 180 to 220 g, underwent simulated mild, moderate and severe experimental peritonitis according to the standard method. Samples of optically thin histological sections of the small intestine of rats with different severity of the course of peritonitis were used as the research object.&#x0D; Results. As a result of the study, a structural and logical scheme for studying the effectiveness of differential diagnosis of the severity of peritonitis by means of statistical analysis of the structure of the distribution of phases of microscopic images of biological preparations of rats was developed, which helped to determine the relationships between the distribution of statistical parameters of the 1st–4th orders, which characterize phase maps depending on the severity of the peritonitis course.&#x0D; Conclusion. The revealed changes in the statistical structure of phase maps fully correlate with the measurement data for the polarization phase manifestations of the properties of the polycrystalline component of histological sections, both in the case of the phase measurement of polycrystalline blood films and the wall of the small intestine.

Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis.

The COVID-19 pandemic has raised concerns about the negative impact of the fear of contagion on people’s willingness to seek medical care and the subsequent effects on patients’ prognosis. To date, not much is known about the outcomes of acute surgical diseases in this scenario. The aim of this multicenter observational study is to explore the effects of COVID-19 outbreak on the outcomes of patients who underwent surgery for peritonitis. Patients undergoing surgery for secondary peritonitis during the first COVID-19 surge in Italy (March 23–May 4, 2020—COVID period group) were compared with patients who underwent surgery during the same time interval of year 2019 (no-COVID period group). The primary endpoint was the development of postoperative complications. Logistic regression analysis was conducted to identify predictors of complications. Of the 332 patients studied, 149 were in the COVID period group and 183 were in the no-COVID period group. Patients in the COVID period group had an increased frequency of late presentations to the emergency departments (43% vs. 31.1%; P = 0.026) and a higher rate of postoperative complications (35.6% vs. 18%; P < 0.001). The same results were found in the subset analysis of patients with severe peritonitis at surgical exploration. The ASA score, severity of peritonitis, qSOFA score, diagnosis other than appendicitis, and COVID period resulted independent predictors of complications. During the COVID-19 pandemic patients with peritonitis had a higher rate of complicated postoperative courses, weighing on hospital costs and assistance efforts already pressured by the ongoing sanitary crisis.