[Surgical management of peritonitis and sepsis]

The intraabdominal sepsis is one of the major surgical problems today. The Systemic Inflammatory Response Syndrome in peritonitis often leads to multiple organ failure. The surgical eradication of the infectious focus is the most important prerequisite for a successful treatment. Dependent on the form and severity of the local inflammation, different forms of abdominal lavage can be applied. Using surgical and physiological as well as organ failure scores like the Mannheimer-Peritonitis-Index (MPI), the APACHE-II and the Septic-Severity-Score (SSS), the prognosis can be objectively assessed and different clinical studies can be compared. However, in 88 own patients suffering from diffuse purulent peritonitis with sepsis (May 1990 to December 1996), all the above mentioned scores significantly allowed to discriminate surviving (mean MPI: 25, APACHE-II day 1: 19, SSS day 1: 28) from non surviving patients (mean MPI: 31, APACHE-II day 1: 26, SSS day 1: 45). Furthermore, mortality increased significantly with increasing score ranges (< 20, 20 to 30, and > 30 points) for MPI from 0% to 28% to 81%, for APACHE-II day 1 from 20% to 46% to 100%, and for SSS day 1 from 10% to 37% to 71%.