Postoperative peritonitis originating from the duodenum: operative management by intubation and continuous intraluminal irrigation

Background: The mortality rate associated with postoperative peritonitis re mains high, especially when the source of infection cannot be eradicated. S uch is the case with peritonitis arising from the duodenum, as primary clos ure is futile and intubation alone may be followed by local complications. Methods: Forty-nine consecutive patients with postoperative peritonitis ori ginating from a duodenal leak and a mean Acute Physiology And Chronic Healt h Evaluation II score of 17.7 were treated according to the following proce dure: a three-channelled spiral drain was inserted through the leak and ext raluminal drains were placed near the duodenal defect. Intraluminal irrigat ion was undertaken immediately through the infusion channel of the spiral d rain. Results: Eleven patients died and 26 suffered complications. The mean durat ion of intubation was 21 days. Conclusion: Intubation with intraluminal irrigation has proved effective in a homogeneous group of patients with peritonitis due to duodenal leakage.