[New developments in the pathogenesis and treatment of peritonitis]

The authors put forward the idea that a leading factor in the pathogenesis of acute generalized peritonitis (AGP) is not inflammation but intoxication approaching in its intensity that of bacterial-toxic shock. The intoxication appears immediately after the catastrophe in the abdominal cavity, results in the microcirculation disturbances in all inner organs, degenerative changes in the small bowel nerves, etc. Damages in the organs due to intoxication develop several hours earlier than peritoneal inflammation which is influenced by the intoxication. The patients die during the toxic stage after the operation not from the peritoneal inflammation which is lacking but from the irreversible homeostatic disturbances with the signs of bacterial-toxic shock. Some tests for postoperative prognosis and treatment scheme are suggested based on the new concepts of AGP. They proved to be useful in the clinics.