[A case of purulent peritonitis treated by the "in the open" method]

A 35-year-old man is described who had diffuse purulent peritonitis resulting from duodenal ulcer perforation. Due to the extent and progression of inflammatory changes the abdominal wall was not sutured and the peritoneal cavity was repeatedly controlled. The patient was operated on as an emergency case in the 49th hour after appearance of clinical symptoms. About 5 1 of pus was found in the peritoneum, with fibrin-caused adhesions between intestinal loops with their segmental occlusion. The hole in the duodenal wall was sutured with single sutures, the abdominal cavity was washed with about 10 1 of. 0.02% hibitane solution. Further controls of the abdominal cavity were done on days 3 and 5 after operation removing a small abscess between intestinal loops on the 3rd day and reducing recent ileus due to gumming up of loops on days 3 and 5. During the last control the Child-Philips procedure was done in anticipation of another ileus. After finding of complete absence of inflammatory peritoneal changes the abdominal wall was closed ith sutures. The patient was discharged on the 30th day with a healed surgical wound. Control examination after 7 months showed a very good general condition and linear scar at the site of duodenal perforation.