[Management of tertiary peritonitis in the patients complicated with intestinal fistula]
Jian-an Ren1, Ge-fei Wang, Chao-gang Fan
1Department of General Surgery, Jinling Hospital, Nanjing University of Medical School, Nanjing 210002, China. jan@medmail.com.cn
Objective:
To investigate the etiology and management of tertiary peritonitis in the patients with intestinal fistula.
Methods:
One hundred and fifty-three cases of intestinal fistula complicated with tertiary peritonitis were reviewed. The microbiological characteristics, treatment Methods and outcomes were analyzed.
Results:
There were 114 males and 39 females with a mean age of (42+/- 19) years. The main causes of intestinal fistula included gastrointestinal surgery (40.5%), trauma (31.4%) and severe pancreatitis (14.4%), etc. The most common cultured bacteria of 157 specimens from 79 patients with tertiary peritonitis were Escherichia coli (24.2%), Pseudomonas aeruginosa (12.1%), Staphylococcus aureus (10.8%), Enterobacter cloacae (10.2%), Klebsiella pneumoniae (8.3%). Debridement of the necrotic tissues, drainage of the abscess, continuous rinsing plus negative pressure drainage and antibiotics treatment were performed in 52 cases. Nineteen patients only changed from simple tube drainage to continuous rinsing plus negative pressure drainage. Twenty- eight patients changed to continuous rinsing plus negative pressure drainage and received antibiotics as well. Thirty- six patients received antibiotics and ecoimmune nutrition, while 18 patients only received ecoimmun nutrition.
Conclusions:
Intestinal fistula complicated with tertiary peritonitis was mainly caused by residual infectious focus and inappropriate drainage. The rational treatments include reoperation for debridement of the necrotic and infectious tissues, changing drainage to continuous rinsing plus negative pressure drainage, appropriate usage of antibiotics, and ecoimmune nutrition.
Related Concept Videos
Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
Intestinal Obstruction II: Pathophysiology
Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
