Management of diffuse peritonitis by prolonged postoperative peritoneal lavage

ABSTRACT

Prolonged postoperative peritoneal lavage has been used as a part of the management of 55 patients with diffuse peritonitis. The lavage technique consisted of 60 min cycles of instillation and drainage of a lavage fluid into the peritoneal cavity via a peritoneal dialysis catheter. The lavage fluid was slightly salt solution containing antibiotics, usually cefotaxime and metronidazole. The overall mortality rate in the series was 11% [6/55]. Only one of these patients had residual abdominal sepsis present at postmortem the remaining deaths being due to a progression of the preexisting disease. Five patients showed evidence of further intraabdominal sepsis. In three of these patients, this was associated with the presence of a previously well established abscess cavity. The overall results indicate that for this group of patients recognized to be high risk of mortality or further sepsis, the use of prolonged postoperative peritoneal lavage is associated with an improved outcome: