[Postoperative peritonitis: epidemiology, diagnosis, surgical treatment and prognosis].

Abstract

Postoperative peritonitis is a rare but dangerous complication of gastrointestinal tract surgeries. Analysis of epidemiology, diagnostics, treatment, and prognosis of postoperative peritonitis was based on 35 manuscripts. Postoperative peritonitis is an uncommon (up to 6-7%) but dangerous complication with mortality rate >30%. Old age, comorbidities, impaired sealing of proximal digestive tract and delayed redo laparotomy are the main factors of high mortality. Late diagnosis of peritonitis is due to no specific signs, and its symptoms are explained by peculiarities of postoperative period and not associated with complication. Surgical treatment consists in eliminating the source of peritonitis or its effective isolating from abdominal cavity, adequate debridement and drainage of the abdominal cavity. The APACHEII scale and the Mannheim Peritonitis Index (MPI) are the most important in assessing the prognosis of peritonitis. The time of the first relaparotomy may be a sign of disease prognosis. The issues of early diagnostics of postoperative peritonitis remain unresolved that necessitates searching for the causes of late relaparotomy and high subsequent postoperative mortality.