Which Surgical Strategy in Sepsis from Retro Peritoneal Colic Perforation

Abstract

Introduction: In the last decade, attention has been paid to severe abdominal infections which, due to their severity and difficulty in treatment, cause death in 30-60% of cases [1][2][3][4][5][6]. In this article the surgical strategies in abdominal infections due to colonic perforation are discussed. Materials and Methods:The study was carried out on 12 patients from January 01.01.2015 to December 31.12.2018 consulting in retrospect the Database and medical records of ' AOU Policlino University of Catania. Department of Medical Surgical Specialties II. In the selection of patients undergoing surgery for retro peritoneal intestinal perforation n 10 cases affected the colorectal, n 2 ileum cases, Patients n 8 were male, and the remaining 4 cases were female with an average age of 62 years .Result: Alongside the known advantages of the minimally invasive approach (20% of cases treated) such as less postoperative pain, shorter hospital stays, less morbidity, in cases of acute abdomen the possibility of avoiding at first was considered instance the laparotomy, burdened by itself with a morbidity that varies from 5 to 22% [6,62,63] and the possibility, in case of conversion, to perform a laparotomy "calibrated" to the clinical picture, in the presence of perforations from more than 24 hours, with a diameter> 1 cm, in addition to a poor performance status and / or hemodynamic instability. Discussion:The data in the literature agree in affirming the central role of surgery in the treatment of patients with abdominal sepsis [1][2][3][4][5][6][11][12][13]62], but despite the progress of the last few years the mortality of these patients remains unacceptably high (30-60%) and more often than not more interventions are needed surgical procedures aimed at eradicating sepsis. The objectives of the surgical treatment were:a) The timely diagnosis of sepsis.b) The identification and elimination of all the collections. c) The repair or removal from the peritoneal cavity of the source of contamination ne. d) Closure of the abdominal wall without high tension e) Careful monitoring of any septic persistence or recurrence. Control of the peritonal contamination source was obtained by resection of colonic perforation of the entire segment -ressed and the creation of an upstream enterostomy (Hartmann's intervention) which represents the most rational choice since a primary anastomosis packaged in a septic medium has a high probability of dehiscence. Conclusion:In cases of retroperitoneal sepsis, as well as in the adequate evacuation (surgical and / or percutaneous) of the infected collections, an effective antibiotic therapy, with an adequate nutritional supply that represents the most effective therapeutic scheme, The most important success variables identified are the careful selection of patients and the availability of a medical (Intesiva therapy) and surgical team dedicated to this pathology.

Intraoperative Peritoneal Lavage in Peritonitis: Normal Saline vs Metronidazole

“…In another Study of Tait, the solution of blood and warm water was introduced in the abdomen and all internal organs washed until the water ran clear. Amniotic fluid, 25% glucose, water, saline, and different antibiotics were some of the fluids utilized in peritoneal lavage and aspiration in the past 16 . Peritoneal lavage can lessen the number of germs in the body by dilution, which in turn decreases the risk of infection and septic shock at the wound site.…”