Types Of Peritonitis Research Articles

Clinical Profile and Management of Perforation Peritonitis in a Tertiary Care Centre, Kerala, India

Peritonitis, an inflammation of the peritoneum and peritoneal cavity, is often brought on by a localised or systemic infection. Primary and secondary peritonitis are the two types of peritonitis. Once the clinical diagnosis of peritonitis is made, rapid institution of both physiologic support and aggressive anti-infective therapy are imperative. The objective was to study the frequency of perforation peritonitis in relation to various parameters ,and to study the post-operative complications and mortality. Cross-sectional study was conducted during the time period of 1 year. Findings were noted intra-operatively, patients were followed up until discharge or death. It was found that males were more affected than females, and majority was in the 21-35 years age group. Most common perforation was appendicular perforation followed by gastric and small intestine perforation. Diagnosis is made clinically and confirmed by presence of free gas under diaphragm. Mortality was 10% and the most common post-operative complication was wound infection.

Concentrations of neutrophil gelatinase-associated lipocalin are increased in serum and peritoneal fluid from horses with inflammatory abdominal disease and non-strangulating intestinal infarctions.

Neutrophil gelatinase-associated lipocalin (NGAL) is produced in response to inflammation in horses, but it has not yet been investigated as a biomarker in horses with the abdominal disease. To investigate NGAL in serum and peritoneal fluid in horses with the abdominal disease. Retrospective clinical study. Data from medical records of 270 horses admitted with acute abdominal disease (simple obstructions [n=43], strangulating obstructions [n=104], inflammatory abdominal disease [n=99], non-strangulating intestinal infarction [NSII, n=24]) and 9 healthy control horses were reviewed, and serum and peritoneal fluid samples were retrieved from a biobank. NGAL was measured in serum and peritoneal fluid by ELISA. Differences in NGAL concentrations between groups were assessed. Healthy horses had low serum and peritoneal fluid concentrations of NGAL (median=21.0 and 9.5μg/L, respectively). Neither serum nor peritoneal fluid NGAL concentrations (median serum, peritoneal fluid) differed between healthy horses and horses with simple (28.1μg/L, 13.0μg/L) and strangulating intestinal obstructions (34.7μg/L, 38.4μg/L). Horses with NSII (308.0μg/L, 2163.0μg/L) and inflammatory abdominal disease (171.1μg/L, 314.1μg/L) had higher serum and peritoneal fluid concentrations of NGAL than the other groups (p < 0.001). Peritoneal fluid NGAL concentrations in horses with NSII were higher than in horses with inflammatory abdominal disease (p= 0.03). Retrospective study design; small group of control horses. NGAL is a marker of inflammation in horses with the abdominal disease. The high peritoneal fluid concentration of NGAL in horses with NSII compared to all other groups may render NGAL useful for identifying this condition, which is otherwise difficult to differentiate from other types of peritonitis. Thereby, NGAL may potentially facilitate timely surgical intervention in this group of patients. The results of this study must be evaluated in larger, and preferably prospective, studies to obtain a more comprehensive evaluation of the diagnostic utility of NGAL.

WAYS TO IMPROVE THE RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH ATYPICAL FORMS OF ACUTE APPENDICITIS.

The aim: To search for new and improvement of known methods of diagnosis and surgical treatment of atypical forms of acute appendicitis. Materials and methods: There were analyzed the results of diagnosis and surgical treatment of 852 patients with atypical course of acute appendicitis, which amounted to 25.3% of the total number of patients in this category. Depending on the chosen diagnostic and treatment tactics, patients with acute atypical appendicitis were divided into two groups: control (n=423) and main (n=429). Results: It was found that among atypical forms of acute appendicitis retrocecal location of the appendix is 61.2% of cases, pelvic - 24.3%, medial - 11.2%, subhepatic - 3.4%. Destructive forms of atypical acute appendicitis occurred in a total of 92.5% of cases, 77.7% of patients had various types of peritonitis. Conclusions: Authors improved and tested a number of diagnostic (rectal thermometry, ethanol test) and operative methods for destructive forms of acute appendicitis complicated by typhoid (including laparoscopic). The proposed diagnostic and treatment algorithm allowed to optimize the treatment tactics of this category of patients and reduce the incidence of complications in the early postoperative period from 9.9% to 3.5% (p<0.001).

Tertiary peritonitis: A disease that should not be ignored.

Intra-abdominal infections can be classified into uncomplicated or complicated (peritonitis). Peritonitis is divided into primary, secondary, and tertiary. Tertiary peritonitis is the less common but the most severe among peritonitis stratifications, being defined as a recurrent intra-abdominal infection that occurs 48 h after a well-succeeded control of a secondary peritonitis. This disease has a complex pathogenesis that is closely related to the capacity of the peritoneal cavity to activate immunological processes. Patients who progress to persistent peritonitis are at an increased risk of developing several infectious complications such as sepsis and multiple organ failure syndrome. Moreover, tertiary peritonitis remains an important cause of hospital death mainly among patients with associated risk factors. The microbiological profile of organisms causing tertiary peritonitis is often different from that observed in other types of peritonitis. In addition, there is a high prevalence of multidrug-resistant pathogens causing this condition, and an appropriate and successful clinical management depends on an early diagnosis, which can be made easier with the use of clinical scores presenting a good prediction value during the intensive care unit admission. Complementarily, immediate therapy should be performed to control the infectious focus and to prevent new recurrences. In this sense, the treatment is based on initial antimicrobial therapy and well-performed peritoneal drainage.

Frequency, characteristics, and clinical determinants of ‘prodrome’ in familial Mediterranean fever patients

Objective: Prodrome is defined by manifestations that precede a familial Mediterranean fever (FMF) attack and predict its emergence. We aimed to determine the frequency, characteristics, and clinical determinants of prodrome in patients with FMF.Method: This cross-sectional study was conducted in a tertiary rheumatology clinic. During the clinical interview, all patients completed a standardized questionnaire about the pre-attack period. Prodrome was defined as the presence of any recurrent pre-attack manifestation occurring at least 4 h before an attack. Patients were classified according to whether they had prodrome of any kind of attack.Results: The study enrolled 401 patients aged 37.7 ± 11.0 years (mean ± sd). Male gender, M694V/M694V, homozygous MEFV mutation, peritonitis, pleuritis, and arthritis were more frequent in prodrome-positive patients. Altogether, 141 patients (35.2%) had prodrome. Male gender and ever having attack types of peritonitis or arthritis were independent clinical determinants of prodrome [relative risk (95% confidence interval): 1.72 (1.07–2.76), p = 0.02; 4.27 (1.80–10.1), p = 0.001; 1.77 (1.04–3.04), p = 0.04, respectively]. Age, MEFV mutations, pleuritis, and erysipelas-like erythema were not clinical determinants.Conclusions: All FMF patients, particularly males and patients who had peritonitis or arthritis at any time, should be questioned about prodrome. Prodrome should be analysed in terms of elucidating the pathogenesis of FMF and as an opportunity for a secondary prevention strategy for impending attacks. This study may shed light on prodrome for future cytokine or drug studies with the purpose of developing new cost-effective treatment protocols irrespective of colchicine resistance.

Factors associated with high-cost hospitalization for peritonitis in children receiving chronic peritoneal dialysis in the United States.

Although peritonitis causes significant morbidity and mortality in children receiving chronic peritoneal dialysis (CPD), little is known about costs associated with treatment. We analyzed 246 peritonitis-related hospitalizations in the USA, linked by the Standardized Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) and Pediatric Health Information Systems (PHIS) databases. Multivariable logistic regression was used to assess the relationship between high-cost hospitalizations (at or above the 75th percentile) and patient characteristics. Multivariable modeling was used to assess differences in the service-line specific geometric mean between (1) high- and low-cost (below the 75th percentile) hospitalizations and (2) fungal versus other types of peritonitis. Wage-adjusted hospitalization charges were converted to estimated costs using reported cost-to-charge ratios to estimate the cost of hospitalization. High-cost hospitalizations were associated with the following: age 3-12years, Hispanic ethnicity, intensive care unit (ICU) stay, length of stay (LOS), and fungal peritonitis. Whereas absolute standardized cost by service line was significantly different when comparing high- and low-cost hospitalizations, the percentage of total cost by service line was similar in the two groups. Cost per case for fungal peritonitis was higher (p < 0.001) in every service line except pharmacy when compared to other peritonitis cases. The median (IQR) cost of hospitalization for the treatment of peritonitis was $13,655 ($7871, $28434)USD. Hospitalization-related costs for peritonitis treatment are substantial and arise from a variety of service lines. Fungal peritonitis is associated with high-cost hospitalization.

Features of the flow of perforations of hollow organs of the abdominal cavity in infectious patients

In the work of the particularities of clinical course of perforation of hollow organs and peritonitis in conjunction with infectious diseases in patients on treatment in infectious and surgical department compared to patients receiving treatment of perforation of hollow organs in “normal” surgical hospital. Analyzed the differences in the level and nature of perforations, types of peritonitis, infectious diseases have reasons for late diagnosis of these complications.

Open abdomen management of intra-abdominal infections: analysis of a twenty-year experience.

No conclusive results on the efficacy and timing of open abdomen (OA) are available, particularly in the setting of intra-abdominal infections. We analyzed outcomes and risk factors retrospectively in a large series of patients managed with an OA during the past 20 y in an effort to clarify this issue. We reviewed the records of 133 patients who underwent treatment with an OA, considering factors related to patient, disease, medical management, and surgical treatment. The end points of the bi-variable analysis were 1-y mortality, calculated from the time of an initial OA procedure, and definitive fascial closure. Most patients (112/133) managed with an OA had one of several types of peritonitis. Many patients had severe clinical conditions (mean Acute Physiology and Chronic Health Evaluation [APACHE] II score was almost 9 points for the study population). With regard to surgical management, the mean (+SD) number of abdominal revisions was 5.9+9.3 during a mean duration of treatment with an OA of 14.3+11.6 d. The overall mortality in the study was 26% (35/133). Bi-variable analysis revealed factors associated with overall mortality to be age, renal and respiratory co-morbidities, edema on an initial chest radiograph, blood pressure, blood glucose and creatinine concentrations; and APACHE II score. The rate of definitive fascial closure was 75% (100/133). Factors associated negatively with fascial closure were respiratory co-morbidity, edema on a first chest radiograph, post-operative mesenteric ischemia as an indication for OA, blood glucose and creatinine concentrations, and duration of an OA. Patients' pre-operative clinical status influences strongly their response to surgical treatment. The management of OA does not affect adversely the survival of patients with intra-abdominal infections, but factors related to the management of OA (duration of OA) seem to affect the possibility of definitive fascial closure.

Course of C‐reactive protein during continuous peritoneal dialysis‐associated peritonitis

C-reactive protein (CRP) levels increase during peritonitis. Little is known about the extent and duration of CRP elevation. Patients on continuous peritoneal dialysis (CPD) therapy had a baseline CRP value at the start of the study. CRP values were determined at 48 h, 2 weeks and 4 weeks after an episode of peritonitis developed in the 13 months after the study started. The demographic values and comorbid diseases of the patients developing and not developing peritonitis were not significantly different. Patients who developed peritonitis had a mean +/- SD CRP value of 15.0 +/- 11.1 mg/L compared with 15.7 +/- 9.9 mg/L in patients without peritonitis. The CRP value rose to 118.35 +/- 96.86 mg/L at 48 h, and decreased to 34.5 +/- 43.6 mg/L at 2 weeks and to 30.1 +/- 39.7 mg/L at 4 weeks after the onset of peritonitis. All types of peritonitis were associated with a significant increase in CRP at 48 h. Nine patients had CRP elevations above baseline at 4 weeks; seven patients had active medical issues. CRP values become significantly elevated during peritonitis. Most patients have a decrease in the CRP values toward baseline values at 4 weeks following the onset of peritonitis while 20% of patients had continued elevations. The significance of the elevations is unclear. Given the associations of CRP with cardiovascular mortality in both uremic and non-uremic patients and the association of peritonitis with mortality, the role of this inflammatory marker deserves further evaluation.

Icodextrin-induced peritonitis: Study of five cases and comparison with bacterial peritonitis

An epidemic of aseptic peritonitis related to the presence of peptidoglycan contaminant in some batches of icodextrin solution (Extraneal, Baxter Healthcare Corporation) occurred in Europe in the first six months of 2002. By case-control study we examined the clinical and biologic features of 5 patients with icodextrin-induced peritonitis (group AP) and compared them with 7 patients with bacterial peritonitis (group BP) recruited in our clinical center between January and June 2002. Diagnosis of icodextrin-induced peritonitis was confirmed in all cases by a positive reintroduction test with contaminated batches of icodextrin. No recurrence was observed on re-exposure to icodextrin free of peptidoglycan. Skin tests were positive with contaminated icodextrin in 2 of 5 patients, while they were negative with icodextrin solution free of peptidoglycan (<0.6 ng/mL). During peritonitis, serum level of C-reactive protein (CRP) was lower in group AP (42.4 +/- 34 mg/L) than in group BP (135 +/- 59 mg/L) (P= 0.01). Leukocyte number in peritoneal dialysis effluent was lower in group AP (284 +/- 101/mm3), with a lower neutrophil/monocyte ratio (N/M = 0.67) than in group BP (1410 +/- 973/mm3; N/M = 4) (P < 0.05). A low number of peritoneal fluid eosinophilia (11 +/- 8%) was detected in group AP. Icodextrin-induced peritonitis was associated with a burst of intraperitoneal cytokines. The phenotype of peritoneal neutrophils was different between aseptic and bacterial peritonitis, indicating that inflammatory stimuli that activate neutrophils in both types of peritonitis are clearly distinct. Finally, peritoneal injury measured by weight gain, peritoneal permeability, and CA125 concentration seemed to be less severe during icodextrin-induced peritonitis than during bacterial peritonitis.

Abdominal Catastrophe Revisited: The Risk and Outcome of Enteric Peritoneal Contamination

Peritonitis from a visceral source is associated with striking morbidity and mortality in patients treated with peritoneal dialysis (PD). Surgical intervention for both diagnosis and repair is definitive. However, because the antecedents of enteric injury leading to peritonitis are unpredictable, no preventive strategy has been proposed or adopted. The goal of this study was to examine risk factors influencing the occurrence and outcome of anatomically documented peritonitis of enteric origin. Retrospective chart and database review. Peritoneal dialysis unit in tertiary-care referral hospital. 330 patients treated with PD for end-stage renal disease between 1988 and 2000. Prevalence of peritonitis of anatomically documented enteric origin over two consecutive time periods within the study interval: period 1, from 1 January 1988 through 30 June 1996; period 2, from 1 July 1996 through 30 June 2000. At least 1 episode of peritonitis occurred in 202 of 330 patients during the entire study period of 12.5 years (600.74 patient-years of care). There were 543 episodes of peritonitis. Anatomically documented visceral Injury caused bacterial peritonitis in 41 patients with a total of 63 discrete episodes, an incidence rate of 0.1048 per patient-year. Peritonitis-free survival was compared between the two periods using Kaplan-Meier analysis. The curve representing risk distribution for anatomically documented visceral peritonitis remained constant over the two periods, in contrast to improvements found in all other types of peritonitis, taken as a group (p= 0.044). Logistic regression modeling showed that the only risk factor associated with development of anatomically documented visceral peritonitis was older age. There was no influence of race, sex, time on PD, and underlying disease etiology. 31 deaths were attributed to peritonitis during the study period. The mortality rate from enteric peritonitis due to visceral injury was 46.3% (19/41 cases), compared to 7.5% for all other peritonitis taken as a group (12/161 cases, p < 0.0001). The experience at University Hospitals of Cleveland suggests that abdominal catastrophe occurs in approximately 10% of all patients treated with PD, and is associated with high mortality, which has not changed over time. Therefore, peritonitis due to spontaneous visceral injury presents a great diagnostic and therapeutic challenge. It is important to develop a research strategy to understand this devastating complication.

Experimental peritonitis produced by gastric juice, bile or feces.

Seventy-four patients of acute diffuse peritonitis were briefly reviewed. Fecal peritonitis due to perforation of the colon showed a remarkably high mortality, though the operation was carried out in general earlier than in other types of peritonitis. Three types of peritonitis, fecal, gastric juice and bile peritonitis, were produced experimentally in dogs. Changes in blood pressure, hematocrit, plasma protein, plasma volume, water contents of the intestine, acid-base balance and bacterial culture of the blood were studied in each type of peritonitis. Severe hypovolemia was considered to be an important factor in the early development of shock in fecal peritonitis, but hypovolemia alone was not sufficient to account for the extreme severity of fecal peritonitis. Blood culture became positive within a few hours after the onset of fecal peritonitis and severe septicemia, seemed to be another important factor which contributed to aggravation of symptoms in this disease. The present authors, however, could not demonstrate endotoxin-like substance in the circulating blood of dogs with severe fecal peritonitis.

Postoperative decompression of the stomach and jejunum by gastrostomy.

The value of decompression of the stomach and small bowel by means of nasal tubes passed into these organs has been proved in the treatment of paralytic ileus and the various types of peritonitis. Stricture of the esophagus is seen occasionally when nasal tubes have been kept in place for several days. A commoner complication is seen in persons who have bronchiectasis, chronic rhinitis, upper respiratory tract infection, or a poor cardiac reserve. With the use of a nasal tube in such patients, postoperative collapse of the lung or bronchopneumonia is a constant danger. Aged and debilitated patients may have a poor cough reflex, and, following laparotomy, it is often necessary to remove the nasal tube to give the patient a much needed rest and to keep the airways clear of mucus. When performing a laparotomy in such patients, I have used the following maneuver with great success (see the

Treatment of benign paroxysmal peritonitis with para-aminobenzoic acid.

Recently, benign paroxysmal peritonitis has been recognized as a clinical entity.¹Although only a few cases have been reported, it has commanded considerable interest in recent years, especially in relation to a larger group of periodic diseases of unknown cause.² The diagnosis is based on the clinical characteristics of the syndrome and the ruling-out of other types of peritonitis. These clinical findings include periodic bouts of abdominal pain accompanied with fever, a varying degree of leukocytosis, and the physical findings of peritonitis. The duration of the paroxysms may last a few days to two or more weeks. At times the abdominal pain is very severe and the abdominal tenderness marked. Involuntary spasm of the abdominal muscles, constipation, and vomiting are frequently present. At times the region in which pain is found includes the lower portions of the chest, and the pain is aggravated by breathing. The episodes usually

The fallacy of peritoneal drainage

The nondrainage treatment is based not on theory but on overwhelming experimental and clinical evidence. Both experiment and experience have demonstrated beyond any doubt these facts: 1. 1. It is physically and physiologically impossible to drain the peritoneal cavity by any means whatsoever. 2. 2. In all types of peritonitis, removal of the source of infection, aspiration of pus, avoidance of injury to the endothelium and closure of the peritoneum is the only treatment required. If treated within forty-eight hours, the temperature will usually reach normal in three or four days, the exudate will be absorbed and permanent adhesions will rarely, if ever, be formed. 3. 3. With such treatment deaths from peritonitis per se will seldom occur. Most deaths result from delayed operation, allowing abscesses to invade retroperitoneal tissues, from overwhelming toxemia, from mesenteric thrombosis, or from intestinal obstruction resulting from adhesions produced by the drainage tube. 4. 4. Retroperitoneal tissues and the fascia and fat of the abdominal wall have none of the resistance of the peritoneum. Hence they should be drained or left wide open until healthy granulations form. Many such wounds can then be closed by secondary suture. 5. 5. Since the success of nondrainage depends on the integrity of the peritoneum, a drain is indicated if the walls of an abscess are necrotic or lined with a shaggy gray membrane, if the retroperitoneal space is opened, or if bleeding cannot be completely controlled. 6. 6. There need be no hesitation in gently separating fresh fibrinous adhesions in order to reach all collections of pus with the aspirator. Failure to do this may result in a localized abscess. 7. 7. The more widespread the peritonitis, the less the indication for drains. 8. 8. The time to operate is when the diagnosis is made. No surgeon lives who can tell with certainty what is going on inside the abdomen. With nondrainage there is nothing to be gained by delay and everything to be gained by removal of the source of infection as early as possible. 9. 9. Appendiceal peritonitis has been used to illustrate the principles underlying the treatment by nondrainage only because of the great mass of evidence available in that particular field. Removal of the source of infection and omission of the useless and harmful drain is equally important in the treatment of battle casualties. The validity of the method was established beyond question in the last two years of the first World War. With a long war facing us the life of every fighting man who suffers a penetrating wound of the abdomen will depend largely on three things: Control of shock, sulfonamides and nondrainage of the peritoneal cavity.

EXPERIMENTAL PERITONITIS

Probably the most serious types of peritonitis are those in which not only virulent micro-organisms are present in the peritoneal cavity, but, in addition, culture material for the micro-organisms to develop on. This set of conditions is seen in various types of perforative peritonitis or in lesions accompanied by the death of tissue, such as postoperative peritonitis or peritonitis with strangulated hernia. Since it is difficult to produce peritonitis experimentally by the introduction of bacteria alone into the normal peritoneum, it seemed logical to assume that experimental peritonitis could be produced by the introduction of bacteria growing on a culture medium. By such a method it would be possible, theoretically, to study peritonitis produced by a single type of micro-organism or by selected groups of micro-organisms. Accordingly, pure cultures of Bacillus coli, staphylococcus, streptococcus and pneumococcus on agar or blood agar slants were introduced into the peritoneal cavity of dogs

Cardiovascular System in Acute Experimental Peritonitis

The purpose of this work is to determine the reaction of the cardiovascular system to experimental peritonitis. Holzbach1 in his review on circulatory failure in infectious conditions states that functional heart failure appears early in peritonitis, but this opinion is apparently based on clinical observations since no experimental work of this condition is reviewed.Two types of peritonitis were induced in dogs. Fecal peritonitis was produced in 5 dogs by the intraperitoneal introduction of 5 gm. of small and large bowel feces suspended in 25 cc. of saline. Colon bacillus peritonitis was induced in another set of 5 dogs by the intraperitoneal injection of 50 cc. of a 2% gum tragacanth in saline containing 200 million B. coli per cc. In each of the animals blood pressure was obtained prior to and continuously after the onset of peritonitis by insertion into the carotid artery of a cannula which was connected to a mercury manometer and recorded on a kymograph. The animals were under pento-barbital sodium a...