Severity Of Peritonitis Research Articles

Aktuelle Konzepte der perforierten Sigmadivertikulitis

Despite modern therapeutical options,perforated sigma diverticulitis still represents a life-threatening disease. In terms of diagnostic and therapeutic proceeding, the covered perforation has to be distinguished from free perforation.Primary therapeutic objective is the excision of the inflamed bowel segment to avoid abdominal sepsis.Therapeutic options for covered perforation include conservative treatment with or without placement of interventional drains. A free perforated diverticulitis implies the resection of the perforated bowel segment. Primary anastomosis should be aspired. In advanced cases, Hartmann procedure may be required. Individual decision making should be based on individual risk profile, on peritonitis severity score and on surgeon experience. In a two stage procedure, relevant morbidity of the second operation has to be considered.Recently suggested approaches,laparoscopic lavage or interventional drainage without resection, remain a matter of debate.

The Effects of Biocompatible Compared with Standard Peritoneal Dialysis Solutions on Peritonitis Microbiology, Treatment, and Outcomes: The Balanz Trial

A multicenter, multi-country randomized controlled trial (the balANZ study) recently reported that peritonitis rates significantly improved with the use of neutral-pH peritoneal dialysis (PD) solutions low in glucose degradation products ("biocompatible") compared with standard solutions. The present paper reports a secondary outcome analysis of the balANZ trial with respect to peritonitis microbiology, treatment, and outcomes. Adult incident PD patients with residual renal function were randomized to receive either biocompatible or conventional (control) PD solutions for 2 years. The safety population analysis for peritonitis included 91 patients in each group. The unadjusted geometric mean peritonitis rates in those groups were 0.30 [95% confidence interval (CI): 0.22 to 0.41] episodes per patient-year for the biocompatible group and 0.49 (95% CI: 0.39 to 0.62) episodes per patient-year for the control group [incidence rate ratio (IRR): 0.61; 95% CI: 0.41 to 0.90; p = 0.01]. When specific causative organisms were examined, the rates of culture-negative, gram-positive, gram-negative, and polymicrobial peritonitis episodes were not significantly different between the biocompatible and control groups, although the biocompatible group did experience a significantly lower rate of non-pseudomonal gram-negative peritonitis (IRR: 0.41; 95% CI: 0.18 to 0.92; p = 0.03). Initial empiric antibiotic regimens were comparable between the groups. Biocompatible fluid use did not significantly reduce the risk of peritonitis-associated hospitalization (adjusted odds ratio: 0.80; 95% CI: 0.48 to 1.34), but did result in a shorter median duration of peritonitis-associated hospitalization (6 days vs 11 days, p = 0.05). Peritonitis severity was more likely to be rated as mild in the biocompatible group (37% vs 10%, p = 0.001). Overall peritonitis-associated technique failures and peritonitis-related deaths were comparable in the two groups. Biocompatible PD fluid use was associated with a broad reduction in gram-positive, gram-negative, and culture-negative peritonitis that reached statistical significance for non-pseudomonal gram-negative organisms. Peritonitis hospitalization duration was shorter, and peritonitis severity was more commonly rated as mild in patients receiving biocompatible PD fluids, although other peritonitis outcomes were comparable between the groups.

Laparoscopic sanitation of the abdominal cavity in complex treatment of patients with generalized peritonitis

Aim. To develop a method of programmed laparoscopic sanitation in patients with generalized forms of peritonitis with the use of low-frequency ultrasound energy. Methods. Conducted was an analysis of results of treatment of 211 patients with generalized peritonitis admitted to the surgical department of the City Clinical Hospital №7 from 2000 to 2010. The main group comprised 37 patients in whom laparoscopic sanitation with the use of low-frequency ultrasound was performed. The control group included 174 patients who underwent conventional relaparotomy due to progression of the pathological process in the abdominal cavity. Results. The proposed method of laparoscopic sanitation helped to reduce mortality by 12%, and the development of postoperative complications by 8% compared with control group in patients of the II stage of severity of peritonitis according to the Mannheim peritoneal index. Conclusion. The developed method of programmed videolaparoscopic sanitations of the abdominal cavity with the use of low-frequency ultrasound in patients with generalized peritonitis has a pronounced bactericidal and bacteriostatic effect.

Peritoneal computed tomography attenuation values reflect the severity of peritonitis caused by gastrointestinal perforations

Background The aim of this study was to evaluate the peritoneal computed tomography (CT) attenuation values and relate them to the severity of peritonitis in patients with gastrointestinal tract (GI) perforations. Methods A total of 56 consecutive patients with GI perforations who underwent CT scan and emergency laparotomy in our hospital were enrolled in this study. The CT attenuation values of the peritoneum were measured on a workstation by 2 independent investigators, and were investigated in relation to the severity of illness and hospital mortality. Results Peritoneal CT attenuation values in hospital nonsurvivors were significantly lower than those in survivors. There was significant negative correlation between peritoneal CT attenuation values and sequential organ failure assessment score, acute physiology and chronic health evaluation II score, and the Mannheim peritonitis index. Conclusions The evaluation of peritoneal CT attenuation values in patients with peritonitis is simple and can be used for objective assessment of the severity of peritonitis.

Management and outcome of high-risk peritonitis: a retrospective survey 2005–2009

To describe the clinical and microbiological aspects of high-risk peritonitis and to analyze their impact on its outcome. This was a retrospective review of all culture-positive peritonitis between October 1, 2005 and September 30, 2009. In accordance with recent Infectious Diseases Society of America (IDSA) guidelines, a group of high-risk peritonitis patients was selected based on age, severity of illness, underlying diseases, and acquisition of the infection. Ninety-three patients with high-risk peritonitis were studied; these patients were divided into subgroups of those with community-associated disease (14%) and those with healthcare-associated disease (86%). The median age of patients was 66 (interquartile range (IQR) 22-95) years. The 30-day mortality rate was 25%. Subgroups differed in age (p=0.011), degree of comorbidity (p=0.023), severity of peritonitis (p=0.036), admission to the intensive care unit (ICU) (p=0.002), length of ICU stay (p<0.001), length of hospital stay (p<0.001), cure at day 30 (p=0.001), and adequate treatment (p=0.042). The microbiological etiology and resistance profiles were similar between the patient groups. Adequate empirical treatment was not related to a better outcome. Severity of disease (p=0.005) and the presence of enterococci (p=0.044) were independently associated with mortality. The mode of acquisition influences severity and certain parameters of outcome in high-risk peritonitis, but not its microbiological etiology. The outcome seems to depend primarily on severity of peritonitis and much less on the adequacy of treatment.

Assessment of predictors of mortality and severity in patients with colorectal perforation.

Colorectal perforation is a life-threatening disease with high mortality and morbidity. The correct and prompt diagnosis and accurate judgment of severity are necessary. We retrospectively investigated 30 patients with colorectal perforation to assess predictors of mortality and severity, and evaluated the usefulness of computed tomography (CT) for the initial diagnosis. The severity of peritonitis was assessed using clinical factors and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) scores. Abdominal free air was detected by CT in 92% of patients with colorectal perforation, whereas only 36.6% showed evidence of abdominal free air by conventional radiography. The perforation site was correctly diagnosed in 14 of 25 cases (56%). Overall mortality was 16.7%. Survivors were younger than nonsurvivors, and POSSUM physiological and mortality scores were significantly lower for survivors compared with nonsurvivors. The amount of intraperitoneal soiling by large bowel content determined disease severity in terms of the need for postoperative respiratory management. In conclusion, CT is necessary for precise diagnosis, and the POSSUM score is helpful for the evaluation of disease mortality and severity.

Leptin and leptin receptor polymorphisms are associated with poor outcome (death) in patients with non-appendicular secondary peritonitis

IntroductionLeptin (LEP) and its receptor (LEPR) participate in the immunological response during infection. LEP serum levels rise during sepsis. In patients with peritonitis, an insufficient elevation in serum LEP is associated with an increased risk of death. As gene variants of LEP and LEPR have been associated with diverse pathologic conditions, we explored the association of genetic polymorphisms of LEP or LEPR with death in patients with secondary peritonitis.MethodsA case control study was undertaken. LEP Gene -2548G > A and the LEPR Gene 223A > G polymorphism were determined in 74 patients. The odds ratio of genotype and allele distribution in survival (control) versus death (case) among patients was calculated. Serum LEP, interleukin (IL)-6, tumour necrosis factor alpha, C-reactive protein (C-RP), IL-10 and IL-13 levels were analyzed in 34 patients.ResultsThere were significant differences in genotype and allele distribution between survivors and non-survivors for -2548G > A and 223A > G polymorphisms. The presence of the mutant allele A, in -2548, had an odds ratio of 4.64 (95% CI 1.22, 17.67) with significance (P = 0.017) in the risk of death. The presence of mutant allele G, in 223, had an odds ratio of 3.57 (95% CI 1.06, 12.01) with significance in the risk of death (P = 0.033). The presence of allele A in the -2548 polymorphism was associated with differences in serum LEP (P = 0.013), and IL-10 (P = 0.0001). The presence of allele G in 223 polymorphism was likewise correlated with differences in serum LEP (P < 0001), C-RP (P = 0.033), and IL-10 (P = 0.043).ConclusionsThe polymorphisms studied are associated with death in patients with peritonitis of non-appendicular origin. This association is stronger than many known risk-factors related to peritonitis severity, and is independent of body mass. The physiopathologic mechanism is possibly related to an insufficient increase in the elevation of serum LEP levels, and is unrelated to body mass.

Predictors of Outcome Following Surgery in Colonic Perforation: An Institution’s Experience Over 6 Years

BackgroundColonic perforation is associated with abysmal outcome. The aims of our study were to review the surgical outcome of patients with perforated colon and to identify factors predicting peri-operative complications. MethodsA retrospective review of all patients who underwent surgery for colonic perforation from January 2003 to August 2008 was performed. Patients with iatrogenic or traumatic perforation were excluded. The severity of abdominal sepsis was graded using the Mannheim peritonitis index (MPI). ResultsA total of 129 patients, with median age of 65 years (22–97 years), formed the study group. While 29.5% had severe peritoneal contamination, 56.6% had an American Society of Anesthesiologists (ASA) score ≥3. Sigmoid colon (47.3%) and caecum (24.8%) were the most common sites of perforation. Diverticulitis and malignancy were the diagnoses in 51.9% and 34.9%, respectively. Hartmann’s procedure and right hemicolectomy were performed in 43.4% and 34.1% of the patients, respectively. Stoma was created in 59.7%. The in-hospital mortality rate in our series was 15.5%. After multivariate analysis, the independent variables associated with worse peri-operative complications were ASA score ≥3, MPI >26 and creation of stoma. Malignant perforation was associated with higher ASA score and lower haematocrit level compared to diverticular perforation. Stoma was created more frequently in patients with MPI >26 and left-sided perforation, and was associated with worse complications. ConclusionsSurgery for colonic perforation is associated with high morbidity and mortality rates. Short-term outcome is determined by ASA score and severity of peritonitis. A lower haematocrit level must alert the possibility of malignancy.

The Grade–Response Relation between Severity of Peritonitis and Serum Cytokine Concentrations Explains Mannheim Peritonitis Index Threshold

To explore the gradient between the acute-phase response (APR) and peritonitis of differing severity. In 202 patients with peritonitis, we determined serum concentrations of interleukin (IL)-6, IL-10, IL-13, tumor necrosis factor (TNF)-alpha, and C-reactive protein (CRP). The severity of peritonitis was graded in accordance with the Mannheim Peritonitis Index (MPI). The grade-response relation between the severity of peritonitis and each analyte was explored. A statistically significant association was found between the medians of severity of peritonitis and IL-6 (p < 0.025), TNF-alpha (p < 0.01), CRP (p < 0.033), IL-10 (p < 0.0001), and IL-13 (p < 0.004). Both TNF-alpha and IL-10 had a direct, and IL-13 an indirect, relation to severity, whereas CRP and IL-6 tended toward linear behavior in equilibrium. A significant association persisted between individual MPI scores and IL-6 (p < 0.002), TNF-alpha (p < 0.002), CRP (p < 0.002), and IL-10 (p < 0.001), but not IL-13 (p = 0.646). Around the mean value of grade II peritonitis, the equilibrium between pro-inflammatory and anti-inflammatory cytokines is lost. This change coincides with the 26-point threshold for the MPI.

Prognostic factors of the mortality of postoperative intraabdominal infections

We investigated the relationship between the prognostic factors of postoperative peritonitis and mortality. Data from 56 patients re-operated for postoperative secondary peritonitis in our hospital between 1991 and 2001 were collected retrospectively. Demographic features, comorbidity, malignancy, organ failure, type and timing of the primary operation, intraoperative findings, etiology of postoperative peritonitis, number of relaparotomies, source control failure, Mannheim peritonitis index (MPI), and mortality were noted. The time intervals between the first operation and relaparotomy, and between symptom onset and the second operation were also noted. The overall mortality rate was 32% (n = 18). Organ failure (p = 0.001), time elapse between symptoms and the second operation (p = 0.046), severity of peritonitis (p = 0.035), source control failure (0.047), and MPI scores (p = 0.032) were significantly related with the mortality of postoperative peritonitis in a univariate analysis. MPI score >30 had a higher mortality rate. Delaying relaparotomy for more than 24 h and presence of organ failure result in higher mortality.

Surgery for perforated colorectal malignancy in an Asian population: an institution’s experience over 5 years

Perforated colorectal malignancy is associated with numerous peri-operative complications and dismal long-term survival. The study aimed to review the outcome and factors predicting peri-operative complications and long-term survival of patients who underwent surgery for perforated colorectal malignancy. A retrospective review of all patients who underwent operative intervention for perforated colorectal malignancy from February 2003 to April 2008 was performed. The severity of peritonitis was graded using the Mannheim peritonitis index (MPI). Forty-five patients, median age 67 years (36-97 years), formed the study group. Sigmoid colon (37.8%) and cecum (28.9%) were the most common sites of perforation. Sixteen (35.6%) patients had stage IV disease, while 14 (31.1%) had severe peritoneal contamination (MPI >26). Hartmann's procedure and right hemicolectomy were performed most frequently in 17 (37.8%) and 15 (33.4%) patients, respectively. The mortality rate in our series was 17.8%, with another 26.7% requiring surgical intensive care unit care. The independent variables predicting worse perioperative complications were American Society of Anesthesiologists (ASA) score >or= 3 and MPI >26. Left-sided perforation was the only independent factor predicting stoma creation. The only factor predicting long-term survival was the stage of malignancy (p<0.001). The overall mean survival time for stage II, III, and IV disease were 63.7, 38.1, and 13.8 months, respectively. Surgery for perforated colorectal malignancy is associated with high morbidity and mortality rates. Short-term outcome is determined by ASA score and severity of peritonitis, while long-term outcome is determined by staging of the cancer.

Prospective study of procalcitonin as a diagnostic marker of the severity of secondary peritonitis

IntroductionIt has been shown that procalcitonin (PCT) is a good marker for sepsis as the more severe the infection the higher the plasma levels. The Mannheim peritonitis index (MPI) is very effective in assessing the prognosis of secondary peritonitis. The aim of this study is to find out whether there is any correlation between preoperative PCT levels and the postoperative MPI, as well as the prognostic value of preoperative PCT levels. Patients and methodProspective study of 57 patients operated on between December 2006–August 2008 for secondary peritonitis and classified into 3 groups (A: 23 patients, B: 24 patients, and C: 10 patients) from lowest to highest severity of MPI. The preoperative values of procalcitonin were obtained with PCT-Q test (BRAHMS). ResultsPCT-Q was normal (<0.5ng/mL) in 19 patients in group A, in 2 patients in group B, and none in group C (P<.001). PCT-Q between 2–10ng/mL were found in 1 patient in group A, 13 in group B, and none in group C (P<.001). PCT-Q>10ng/mL were found in 10 cases in group C, 6 in group B, and none in group A (P<.001). Of the 19 patients admitted to the intensive care unit, the PCT-Q was >10ng/mL in 15 cases vs a PCT-Q<10mg/mL (P<.001) in 4 cases. Seven patients died, all of them with a PCT-Q>10mg/mL (P<.001). ConclusionsThe correlation between preoperative PCT-Q and postoperative MPI is positive and significant. The values of PCT-Q are higher as the MPI severity increases. Values >10ng/mL are significant for admission to the ICU and a poor clinical prognosis.

Staged lavage versus single high-volume lavage in the treatment of feculent/purulent peritonitis: a matched pair analysis

Spontaneous and iatrogenic secondary peritonitis remain to have a mortality of 10-30% and significant socioeconomic impact in survivors and especially non-survivors. Data on the most cost-effective treatment are lacking. We therefore studied outcome and resource utilization in a homogeneous cohort of patients with secondary fecal or purulent peritonitis undergoing surgery with source control and two different types of abdominal lavage. Thirty-one consecutive patients with secondary feculent or purulent peritonitis of the lower gastrointestinal tract underwent a single high-volume lavage. That cohort was matched with 31 patients with the same source, extent, and quality of peritonitis treated by source control and staged lavage (intermittent lavage). Patients in both groups were comparable in gender distribution, age, comorbidity, source, extent, and severity of peritonitis with the history of intestinal perforation in the single high-volume lavage group being significantly higher than in the intermittent lavage group (2.0 +/- 1.7 vs. 1.1 +/- 0.8d; p = 0.008). Patients in the single high-volume lavage group had significantly less operations, thus requiring significantly less operation time (OR-time), intensive care unit (ICU)-requirement, ventilatory support, and inotropic support. Patients with secondary fecal or purulent peritonitis in at least two quadrants, undergoing a one step surgical repair including source control, primary anastomosis, and single high-volume lavage with more than 25 l have a comparable outcome to patients treated by staged lavage at significantly lower OR and ICU-utilization.

Efficacy of different treatment regimes against setariosis (Setaria tundra, Nematoda: Filarioidea) and associated peritonitis in reindeer

BackgroundWhen a severe peritonitis outbreak in semi-domesticated reindeer was noticed in 2003 in Finland, the concerned industry urged immediate preventive actions in order to avoid detrimental effects of S. tundra and further economical losses. A research programme was swiftly initiated to study S. tundra and its impact on the health and wellbeing of reindeer.MethodsThe ultimate aim of this study was to test the efficacy of different treatment regimes against S. tundra and associated peritonitis in reindeer. The timing of the trials was planned to be compatible with the annual rhythm of the reindeer management; (1) the treatment of calves in midsummer, during routine calf ear marking, with ivermectin injection prophylaxis and deltamethrin pour-on solution as a repellent against insect vectors, (2) the treatment of infected calves in early autumn with ivermectin injection, and (3) ivermectin treatment of breeding reindeer in winter. The results were assessed using the post mortem inspection data and S. tundra detection. Finally, to evaluate on the population level the influence of the annual (late autumn-winter) ivermectin treatment of breeding reindeer on the transmission dynamics of S. tundra, a questionnaire survey was conducted.ResultsIn autumn, ivermectin treatment was efficient against peritonitis and in midsummer had a slight negative impact on the degree of peritonitis and positive on the fat layer, but deltamethrin had none. Ivermectin was efficient against adult S. tundra and its smf. All the reindeer herding cooperatives answered the questionnaire and it appeared that antiparasitic treatment of reindeer population was intense during the study period, when 64–90% of the animals were treated. In the southern part of the Finnish reindeer husbandry area, oral administration of ivermectin was commonly used.ConclusionAutumn, and to a lesser degree summer, treatment of reindeer calves with injectable ivermectin resulted in decreased severity of peritonitis and perihepatitis in reindeer calves due to setariosis. In the case of necessity for animal welfare reasons, treatment during early autumn round ups should be considered. On the population level, massive and routinely applied antiparasitic treatments can improve the health of breeding reindeer and decrease the mortality and the number of carriers but during the outbreak could not prevent its movement and expansion to the North.

A Leptin Serum Concentration Less than 10 ng/ml Is a Predictive Marker of Outcome in Patients with Moderate to Severe Secondary Peritonitis

Introduction: Leptin is involved in the sepsis syndrome. A possible relationship exists between low leptin levels and peritonitis severity and a poorer prognosis. Objectives: We aimed to corroborate the relationship between low leptin serum levels and death in patients with peritonitis and to explore the associations between leptin and interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-13 (IL-13), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP). Methods: In 230 adult patients with surgically confirmed secondary peritonitis, the Mannheim Peritonitis Index and the serum concentrations of leptin, IL-6, IL-10, IL-13, TNF-α and CRP were determined. Two cohorts were established (leptin ≤10 ng/ml and >10 ng/ml). Death or survival was followed through 30 days. The relationship between leptin (≤10 ng/ml) and death was evaluated using the accumulated incidence ratio (AIR). The association of leptin (dependent variable) with IL-6, IL-10, IL-13, TNF-α and CRP (independent variables) was studied by regression analysis. Results: The general mortality rate was 7.8% and the death AIR was 3.15 (p nonsignificant). A subsample of patients with a Mannheim Peritonitis Index ≧21 was studied, showing a significant AIR of 4.26 (p = 0.017). Regression analysis determined an association only between leptin and IL-6 (p < 0.001), IL-10 (p < 0.047) and CRP (p < 0.001). Discussion: A serum leptin below the threshold of 10 ng/ml is an adverse prognostic marker in patients with moderate to severe secondary peritonitis. The results of the regression analysis suggest that the mechanisms involved are opposing, in that leptin associated with IL-6 has a proinflammatory effect and, through IL-10 and CRP production, restrains the inflammatory response.

The Effects of Endothelin Receptor Blockade by Bosentan on the Healing of a Bowel Anastomosis in an Experimental Crohn’s Disease Model

ObjectiveIt was previously described that endothelins may contribute to the pathogenesis of Crohn’s disease. In this study, it was aimed to investigate the effects of endothelin receptor blockade by bosentan on the healing of a bowel anastomosis in an experimental Crohn’s disease model. Material and MethodsTwenty-eight Sprague–Dawley rats were divided into four groups. Groups I and II were used as sham-operated and control groups, respectively. Bowel inflammation induced by intrajejunal injection of iodoacetamide in groups III and IV. Rats in group IV were treated with oral preparation of bosentan 60 mg/kg/day. Three days after induction of the inflammation, partial resection of test loop and anastomosis was performed. Re-laparotomy was performed, anastomosis bursting pressures and peritonitis scores were measured, and tissue samples were obtained for the measurements of tissue hydroxylproline level and mucosal damage index 4 days later. ResultsThe mean mucosal damage index and peritonitis score of group IV were significantly lower, and the mean tissue hydroxyproline level and anastomotic bursting pressure of group IV were significantly higher than those of group III. ConclusionThe blockade of endothelin receptors by bosentan decreases the severity of iodoacetamide induced intestinal inflammation, increases the wound healing in the inflamed intestinal tissue, and decreases the severity of peritonitis.

Emergency Left Colon Resection for Acute Perforation. Primary Anastomosis or Hartmann’s Procedure? A Case‐matched Control Study

The optimal treatment remains controversial for acute left-sided colon perforation. Therefore, the effectiveness and safety of primary anastomosis versus Hartmann's operation (HP) was compared in a case-matched control study. Thirty consecutive patients with primary anastomosis and protective ileostomy (PAS) were matched to 30 HP patients, controlling for age, gender, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and peritonitis severity (Hinchey). In a second analysis, PAS patients with purulent peritonitis (Hinchey 3) were matched to patients with primary anastomosis without ileostomy (PA). Hospital mortality was similar between HP (17%) and PAS (10%). Complication frequency and severity (requiring re-intervention or admission to the Intensive Care Unit [ICU]) were comparable for the first operation (60% versus 56% and 30% versus 32%). The stoma reversal rate was higher in PAS than in HP (96% versus 60%, p = 0.001), with significantly fewer complications (23% versus 66%, p = 0.02), and lower severity (7% versus 33%, p = 0.02). Additional analysis of PAS versus PA showed similar morbidity (52% versus 41%, p = 0.45) and complication severity (18% versus 24%, p = 0.51), whereas overall operation time and hospital stay were significantly shorter in PA (169 versus 320 min, p = 0.003, 17 versus 28 days, p < 0.001). Primary anastomosis and protective ileostomy is a superior treatment to HP in acute left-sided colon perforation. In the absence of feculent peritonitis an ileostomy appears unnecessary.

Severity Scoring Systems for Prognosis and Efficacy of Polymyxin B-Immobilized Fiber Treatment for Colonic Perforation

There is no established system for predicting prognosis and evaluating the efficacy of antiseptic treatments such as polymyxin B-immobilized fiber (PMX) according to the severity of peritonitis in patients with colonic perforation. We investigated the predictive value of various severity scoring systems for survival and for the efficacy of antiseptic treatments, to identify high-risk patients. We reviewed 26 consecutive patients who underwent emergency operations between 1996 and 2003 for colorectal perforation not caused by trauma or iatrogenic disease. Several severity scores, i.e., Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Mannheim Peritonitis Index (MPI), and Multiple Organ Failure (MOF) were calculated and analyzed as predictive scoring systems for prognosis, survival and efficacy of PMX treatment. An APACHE II score of 19, a SOFA score of 8, an MPI score of 30, and an MOF score of 7 or more were significantly related to a poor prognosis. With or without PMX treatment, an APACHE II score of 15 or less, a SOFA score of 7 or less, an MPI score of 27 or less, and an MOF score of 7 or less were all related to a good prognosis. Conversely, all patients died when the severity scoring points were higher than 20 in APACHE II, higher than 12 in SOFA, and higher than 39 in MPI. When PMX treatment was given to patients with an intermediate score, no correlation between survival and its efficacy was found, except in the MOF scoring system. These severity scoring systems can assist with the prediction of prognosis. They may also be useful for determining if PMX treatment would be unnecessary or ineffective in certain patients. However, the optimal application of PMX treatment in selected patients according to the severity scoring systems needs further investigation.

Comparative study of left colonic Peritonitis Severity Score and Mannheim Peritonitis Index

Prognostic evaluation of patients with left colonic perforation is useful in predicting mortality. The aims of this prospective study were to determine the prognostic value of the left colonic Peritonitis Severity Score (PSS) and to compare it with the Mannheim Peritonitis Index (MPI). One-hundred and fifty-six patients underwent emergency operation for distal colonic peritonitis. The PSS and MPI were calculated for each patient. The Spearman rank correlation coefficient was used to measure the association between the two scores. The predictive power of the two scoring systems and their differences were studied using the area under the receiver-operator characteristic (ROC) curve. Forty-one patients died (26.3 per cent). The relationship between scores and mortality was statistically significant for each scoring system (P < 0.001). The Spearman rank correlation coefficient for the correlation between the MPI and PSS was 0.55 (P < 0.001). There was no difference between areas under the ROC curves for the two systems. The PSS and MPI are both well validated scoring systems for left colonic peritonitis. Their routine use might allow stratification of patients according to mortality risk.

Experimental peritonitis induced by oral administration of indomethacin in Mongolian gerbils

The possibility of inducing peritoneal inflammation in three murine species (gerbils, rats and mice) via the oral administration of indomethacin was investigated with the overall aim of developing an experimental animal model for human peritonitis. Gerbils given high doses of indomethacin at a rate of 30 mg and 40 mg/kg body weight showed swelling of the abdomen, depression and dyspnea within 4 days after the treatment. The severity of the clinical symptoms increased with time. The animals were confirmed as having developed peritonitis based on the pathological features including inflammation of the peritoneum, and fibrinous adhesion of the abdominal organs in the abdominal cavity. The severity of peritonitis increased with increasing dose of indomethacin, and was not related to the gender of the animal. On the other hand, peritoneal inflammation did not develop in the rats and mice even at high doses. Therefore, the administration of 30 mg/kg body weight of indomethacin is an effective and simple method of inducing peritonitis in 5-week-old Mongolian gerbils. The animal peritonitis model used in this study can be used as an effective tool for examining potential therapeutic compounds for preventing peritoneal damage during peritonitis, and provide insight into the pathophysiology of peritonitis.