MANAGEMENT OF ABDOMINAL SEPSIS

Introduction: Today the management of the different forms of peritonit is is generally standardised. The classification of primary and second ary peritonitis is well accepted. From a pathophysiological point of v iew, postoperative and post-traumatic peritonitis should be considered as independent entities. The bacteriological isolates from the inflam ed peritoneal cavity do not correlate with the clinical course, and th e occurrence of enterococci and bacteroides may be slightly related to ongoing infectious complications. Classification: Valuable scoring sy stems mainly rely on systemic signs of the septic disease and seem to better differentiate the prognosis of the disease than more surgically oriented scores do. Although the scoring systems did not allow any cl inical decision, they should be used to help better compare patients t reated in different institutions. The observation of the minor relevan ce of bacteriology and the superiority of general sepsis scores agrees with the fact that pre-existing septic organ dysfunction and pre-exis ting comorbidity are the main determinants of mortality. Treatment. Su rgical therapy focuses on the control of the source of infection becau se it has been clearly shown that, without resolving the source of inf ection, the prognosis remains poor. Adjuvant surgical measures aim at the further reduction of the bacterial load in the peritoneal cavity. Planned relaparotomy, relaparotomy on demand, and continuous closed pe ritoneal lavage are used. Results: Clinical results proved these metho ds to be equally effective although pathophysiological considerations favour closed peritoneal lavage. Conclusion: Summarising the available data, we need a more sophisticated understanding of the pathophysiolo gy of the peritonitis, and well-designed clinical studies are necessar y to define the optimal surgical treatment modalities.