Diffuse postoperative peritonitis -value of diagnostic parameters and impact of early indication for relaparotomy
- PDF / 1,177,514 Bytes
- 6 Pages / 595.228 x 841.842 pts (A4) Page_size
- 2 Downloads / 185 Views
EUROPEAN JOURNAL OF MEDICAL RESEARCH
Eur J Med Res (2009) 14: 491-496
491 © I. Holzapfel Publishers 2009
DIFFUSE POSTOPERATIVE PERITONITIS – VALUE OF DIAGNOSTIC PARAMETERS AND IMPACT OF EARLY INDICATION FOR RELAPAROTOMY F. G. Bader 1, 2, M. Schröder 1, P. Kujath 1, E. Muhl 1, 3, H.-P. Bruch 1, C. Eckmann 1 1 Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany 2 Karolinska Institutet, Karolinska Biomics Center (KBC), Stockholm, Sweden
3 Department
of Surgery, Intensive Care Unit, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
Abstract Objective: Current criteria for performing relaparotomy for suspected peritonitis are non explicit and based on non-quantitative, subjective arguments or hospital practice. The aim of this study was to determine the value of routinely used clinical and diagnostic parameters in early detection of postoperative, diffuse peritonitis (PP). Furthermore, the prognosis and outcome after early indication for relaparotomy in patients with PP compared to community-aquired peritonitis (CAP) was evaluated. Methods: Between 1999 and 2008, a total of 251 patients with diffuse secondary peritonitis either postoperative (PP) or community acquired (CAP) were analyzed retrospectively. PP (n = 114) and CAP (n = 137) were compared regarding physical examination, MPIScore, APACHE II-Score, evidence of organ failure, laboratory parameters, diagnostic instruments and clinical course. The treatment regimen comprised surgical source control (with/without programmed lavage), abdominal closure and relaparotomy on demand, broad spectrum antibiotic therapy and intensive care support. Results: The APACHE II-Score (20 CAP vs. 22 PP, p = 0.012), MPI-Score (27 CAP vs. 30 PP, p = 0.001) and the number of lavages differed significantly. Positive phyiscal testing and signs of sepsis [abdominal pain (81.6% PP vs. CAP 97.1%, p = 0.03), rebound tenderness (21.9% vs. 35.8%, p = 0.02), fever (35.1% vs. 51.8%, p = 0.03)] occurred significantly less often in the PP patients than in the CAP group. Conventional radiography (66.2%) and ultrasonography (44.3%) had a lower diagnostic sensitivity than did abdominal CT-scan (97.2%). Mortality was higher in the PP group but did not differ significantly between the two groups (47.4% PP vs. 35.8% CAP, p = 0.06). Conclusion: The value of physical tests and laboratory parameters in diagnosing abdominal sepsis is limited. CT-scanning revealed the highest diagnostic accuracy. A treatment regimen of early relaprotomy appears to be the most reasonable strategy for as early discovery of postoperative peritonitis as possible. Key words: peritonitis - abdominal sepsis - relaparotomy – diagnosis – treatment
INTRODUCTION
Secondary peritonitis accounts for approximately 90% of all peritonitis cases in western countries [1]. Within this group diffuse postoperative peritonitis (PP) and abdominal sepsis are common concerns following surgical interventions. The current literature indicates a rate of between 30 and 42% for diffuse postoperativ
Data Loading...
