Akutes Abdomen und Peritonitis: Pathophysiologie und Therapiekonzepte

Abstract

Acute Abdominal Pain and Peritonitis: Pathophysiology and Therapeutic Concepts The understanding of pathomechanisms is of utmost importance for diagnosis and treatment of acute abdominal pain and peritonitis. Secondary peritonitis, which includes more than 90% of all patients with peritonitis seen in a surgical unit, usually occurs as a result of gastrointestinal perforation or leakage. The infectious focus first causes local peritonitis and then, depending on the source and the anatomy in the abdominal cavity, diffuse peritonitis may evolve. Regardless whether the process is local or diffuse, inflammatory mediators are released early after onset of disease, amplifying the localised process. The mediators and bacterial toxins maintain a systemic inflammatory response/sepsis syndrome causing organ dysfunction, thereby ultimately being responsible for morbidity and mortality. Since there is no established treatment to block or neutralise systemically released mediators or toxins, controlling the source of infection is the key to success.