Secondary peritonitis: principles of diagnosis and intervention

Ross, John; Matthay, Michael A.; Harris, Hobart W.

doi:10.1136/bmj.k1407

Cited by 101 publications

(85 citation statements)

References 143 publications

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“…Perforated peptic ulcer, with associated peritonitis and sepsis/septic shock, is a medical/surgical emergency requiring rapid evaluation and management [23]. It is crucial to identify parameters to assess the severity of the disease (i.e., to define if a patient is stable or unstable).…”

Section: Resuscitationmentioning

confidence: 99%

Perforated and bleeding peptic ulcer: WSES guidelines

et al. 2020

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Background: Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment. Methods: The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached. Conclusions: The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.

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Section: Resuscitationmentioning

confidence: 99%

Perforated and bleeding peptic ulcer: WSES guidelines

et al. 2020

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“…Bacterial peritonitis caused by E. coli infection is a clinically important problem with a high mortality rate ( 24 ). If infection is not contained and eliminated by phagocytes it can rapidly progress leading to excessive inflammation, epithelial and endothelial barrier dysfunction, immune suppression and multiple-organ failure that can be deadly.…”

Section: Discussionmentioning

confidence: 99%

The GPR40 Agonist GW9508 Enhances Neutrophil Function to Aid Bacterial Clearance During E. coli Infections

et al. 2020

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G-protein-coupled receptor 40 (GPR40) is known to play a role in the regulation of fatty acids, insulin secretion, and inflammation. However, the function of this receptor in human neutrophils, one of the first leukocytes to arrive at the site of infection, remains to be fully elucidated. In the present study, we demonstrate that GPR40 is upregulated on activated human neutrophils and investigated the functional effects upon treatment with a selective agonist; GW9508. Interestingly, GPR40 expression was up-regulated after neutrophil stimulation with platelet-activating factor (10 nM) or leukotriene B 4 (LTB 4 , 10 nM) suggesting potential regulatory roles for this receptor during inflammation. Indeed, GW9508 (1 and 10 μM) increased neutrophil chemotaxis in response to the chemokine IL-8 (30 ng/ml) and enhanced phagocytosis of Escherichia coli by approximately 50% when tested at 0.1 and 1 μM. These results were translated in vivo whereby administration of GW9508 (10 mg/kg, i.p.) during E. coli infections resulted in elevated peritoneal leukocyte infiltration with a higher phagocytic capacity. Importantly, GW9508 administration also modulated the lipid mediator profile, with increased levels of the pro-resolving mediators resolvin D3 and lipoxins. In conclusion, GPR40 is expressed by activated neutrophils and plays an important host protective role to aid clearance of bacterial infections.

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“…Acute peritonitis is the peritoneum inflammation by septic inoculation, usually from an intraperitoneal organ and more rarely after general contamination [1]. This inflammation is of two kinds: the first results from haematogenous spread or iatrogenic contamination of the abdomen without a defect of the gastrointestinal tract; on the other hand, the second is due to a direct contamination of the peritoneum by spillage from the gastrointestinal or urogenital tracts or their associated solid organs [2] [3]. More recently, a third order has been added: tertiary peritonitis, which refers to secondary peritonitis that persists for more than 48 hours after an attempt to control the surgical source [4].…”

Section: Introductionmentioning

confidence: 99%

“…These, unauthorized, are responsible for significant maternal mortality [7] because of the often polymorphous and misleading symptomatology. The principles of surgical management of secondary peritonitis have changed little since the 1900s: eliminating the septic focus, removing necrotic tissue and draining purulent material [2].…”

Section: Introductionmentioning

confidence: 99%

Acute Genital Peritonitis in Brazzaville, Congo

Didace¹,

Alfred²,

Murielle³

et al. 2019

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Genital peritonitis is rare in daily surgical practice in Congo-Brazzaville. Clandestine abortions are incriminated. The purpose of the study is to analyze the epidemiological, etiological, diagnostic and therapeutic aspects of genital peritonitis. A retrospective and case series study was realized in departments of Digestive Surgery and Gynecology-Obstetrics of the University Hospital of Brazzaville. The inclusion criteria for the diagnosis of peritonitis were abdominal pain, fever, transit disturbances and signs of peritoneal irritation. The parameters studied were: age, etiological circumstances, anatomical lesions, type of surgical treatment and evolution. During the study period (July 1, 2015-December 31, 2017), 306 patients were admitted to both departments for acute generalized peritonitis. Among them, a genital cause was incriminated in 18 (5.9%) patients. The mean age was 27.6 ± 3.1 years. At the parity and gestational level, 93% of patients had at least two pregnancies, but not more than the second trimester. In addition, 50% of the patients had an induced miscarriage, due to uterine and intestinal lesions. Induced miscarriages accounted for half of etiological circumstances. Physical examination of the abdomen revealed abdominal contracture in 61.1% of cases. Main visceral lesions were uterine perforation (55.5%) followed by rupture of tubo-ovarian abscess (38.9%). The operative follow-up was simple in 83.33% of cases. In conclusion, genital peritonitis remains unfrequented. Median laparotomy has been the main therapeutic approach in our context where emergency laparoscopic surgery is not yet common.

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Secondary peritonitis: principles of diagnosis and intervention

Cited by 101 publications

References 143 publications

Perforated and bleeding peptic ulcer: WSES guidelines

Perforated and bleeding peptic ulcer: WSES guidelines

The GPR40 Agonist GW9508 Enhances Neutrophil Function to Aid Bacterial Clearance During E. coli Infections

Acute Genital Peritonitis in Brazzaville, Congo

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