Novosti
Khirurgii
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Year 2010 Vol. 18 No 2

GENERAL AND SPECIAL SURGERY

RYCHAGOV G.P., BARSUKOV K.N.

TERTIARY PERITONITIS, CAUSES, DIAGNOSTICS AND TREATMENT

The results of treatment of 130 patients with a tertiary diffuse postoperative peritonitis have been studied. It was found out that the tertiary peritonitis was observed during the postoperative period in case of 22 different abdominal diseases, but more often in case of 6 nosologies such as: acute appendicitis (17,1%), acute cholecystitis (16,1%), closed abdominal trauma (14,6%), complicated gastric and duodenal ulcer (10,7%), acute intestinal obstruction (10%), pancreatitis (8,5%). The main causes of the tertiary peritonitis were the intestinal suture failure (24,8%), the adhesive bowel obstruction (23,8%), bile flow (16,1%), continuing peritonitis (11,5%) etc. The diagnosis of the tertiary peritonitis during the first stage was set in 15,4% of cases, during the second stage in 30,7% and during the third stage in 53,9% of cases. In 84,4% of cases one relaparotomy was performed, in 11,5% two relaparotomies, in 3,3% – three relaparotomies and in 0,82% – four relaparotomies were performed. Total postoperative lethality was 23%. After a single relaparotomy the postoperative lethality made up 21,3%, after twofold relaparotomy – 50%, after threefold relaparotomy – 75%. Prevention of the tertiary postoperative peritonitis is based on the improvement of a therapeutic approach, operative technique during a primary operation and pre- and postoperative treatment.

Keywords: tertiary peritonitis, postoperative peritonitis, relaparatomy
p. 43-49 of the original issue
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