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Background and Aim: Patients with liver cirrhosis often face a grave threat from infected ascites (IA). However, a well‐established prognostic model for this complication has not been established in routine clinical practice. Therefore, we aimed to assess mortality risk in patients with liver cirrhosis and IA. Methods: We conducted a retrospective study across three tertiary hospitals, enrolling 534 adult patients with cirrhotic liver and IA, comprising 465 with spontaneous bacterial peritonitis (SBP), 34 with bacterascites (BA), and 35 with secondary peritonitis (SP). To determine the attributable mortality risk linked to IA, these patients were matched with 122 patients with hydropic decompensated liver cirrhosis but without IA. Clinical, laboratory, and microbiological parameters were assessed for their relation to mortality using univariable analyses and a multivariable random forest model (RFM). Least absolute shrinkage and selection operator (Lasso) regression model was used to establish an easy‐to‐use mortality prediction score. Results: The in‐hospital mortality risk was highest for SP (39.0%), followed by SBP (26.0%) and BA (25.0%). Besides illness severity markers, microbiological parameters, such as Candida spp., were identified as the most significant indicators for mortality. The Lasso model determined 15 parameters with corresponding scores, yielding good discriminatory power (area under the receiver operating characteristics curve = 0.89). Counting from 0 to 83, scores of 20, 40, 60, and 80 corresponded to in‐hospital mortalities of 3.3%, 30.8%, 85.2%, and 98.7%, respectively. Conclusion: We developed a promising mortality prediction score for IA, highlighting the importance of microbiological parameters in conjunction with illness severity for assessing patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract Introduction Secondary peritonitis is the second leading cause of sepsis worldwide. Drug resistance to peritoneal cavity bacterial infection remains a public health threat, especially in resource-limited settings in Africa, including Uganda. This study aimed to determine the antibacterial susceptibility patterns and factors associated with secondary peritonitis among patients with acute abdomen who underwent surgery at a Regional Referral Hospital in Uganda. Methods This was a cross-sectional study conducted at Hoima Regional Referral Hospital (HRRH) that enrolled 126 patients with acute abdomen. Clinical samples were aseptically collected at laparotomy from patients with secondary peritonitis for culture and sensitivity using standard Microbiological methods. Binary logistic regression was used to identify factors associated with secondary peritonitis among patients with acute abdomen. Results The majority of the patients were males (61.9%) with a mean age of 37.9(SD ± 21.8). Secondary peritonitis was found in 57(45.2%) of the patients. Gram-negative bacteria were the most commonly isolated organisms with Escherichia coli (35.8%) and Klebsiella spp (17.0%) predominating. Imipenem 88.8%(8/9), Amikacin 88.8%(8/9), Ciprofloxacin 44.4%(4/9) and Gentamicin 44.4%(4/9) demonstrated sensitivity to the different isolated organisms at varying degrees. Being a male (AOR = 3.658; 95% CI = 1.570–8.519, p = 0.003) and presenting 3 days after onset of symptoms (AOR = 2.957; 95% CI = 1.232–7.099, p = 0.015) were independently associated with secondary peritonitis. Conclusion Imipenem, Amikacin, Ciprofloxacin, and Gentamicin should be considered for empirical therapy in cases of secondary peritonitis. Patients, more especially males with abdominal pain should be encouraged to present early to the hospital to minimize progression to secondary peritonitis.

Abstract Background The high rate of stoma placement during emergency laparotomy for secondary peritonitis is a paradigm in need of change in the current fast-track surgical setting. Despite growing evidence for the feasibility of primary bowel reconstruction in a peritonitic environment, little data substantiate a surgeons’ choice between a stoma and an anastomosis. The aim of this retrospective analysis is to identify pre- and intraoperative parameters that predict the leakage risk for enteric sutures placed during source control surgery (SCS) for secondary peritonitis. Methods Between January 2014 and December 2020, 497 patients underwent SCS for secondary peritonitis, of whom 187 received a primary reconstruction of the lower gastro-intestinal tract without a diverting stoma. In 47 (25.1%) patients postoperative leakage of the enteric sutures was directly confirmed during revision surgery or by computed tomography. Quantifiable predictors of intestinal suture outcome were detected by multivariate analysis. Results Length of intensive care, in-hospital mortality and failure of release to the initial home environment were significantly higher in patients with enteric suture leakage following SCS compared to patients with intact anastomoses (p

Introduction: Secondary peritonitis is the second leading cause of sepsis worldwide. Drug resistance to peritoneal cavity bacterial infection remains a public health threat, especially in resource-limited settings in Africa, including Uganda. This study aimed to determine the antibacterial susceptibility patterns and factors associated with secondary peritonitis among patients with acute abdomen who underwent surgery at a Regional Referral Hospital in Uganda. Methods: This was a cross-sectional study conducted at Hoima Regional Referral Hospital (HRRH) that enrolled 126 patients with acute abdomen. Clinical samples were aseptically collected at laparotomy from patients with secondary peritonitis for culture and sensitivity using standard Microbiological methods. Binary logistic regression was used to identify factors associated with secondary peritonitis among patients with acute abdomen. Results: The majority of the patients were males (61.9%) with a mean age of 37.9(SD ± 21.8). Secondary peritonitis was found in 57(45.2%) of the patients. Gram-negative bacteria were the most commonly isolated organisms with Escherichia coli (35.8%) and Klebsiella spp (17.0%) predominating. Imipenem 88.8%(8/9), Amikacin 88.8%(8/9), Ciprofloxacin 44.4%(4/9) and Gentamicin 44.4%(4/9) demonstrated sensitivity to the different isolated organisms at varying degrees. Being a male (AOR = 3.658; 95% CI = 1.570–8.519, p = 0.003) and presenting 3 days after onset of symptoms (AOR = 2.957; 95% CI = 1.232–7.099, p = 0.015) were independently associated with secondary peritonitis. Conclusion: Imipenem, Amikacin, Ciprofloxacin, and Gentamicin should be considered for empirical therapy in cases of secondary peritonitis. Patients, more especially males with abdominal pain should be encouraged to present early to the hospital to minimize progression to secondary peritonitis. [ABSTRACT FROM AUTHOR]

Background: The high rate of stoma placement during emergency laparotomy for secondary peritonitis is a paradigm in need of change in the current fast-track surgical setting. Despite growing evidence for the feasibility of primary bowel reconstruction in a peritonitic environment, little data substantiate a surgeons' choice between a stoma and an anastomosis. The aim of this retrospective analysis is to identify pre- and intraoperative parameters that predict the leakage risk for enteric sutures placed during source control surgery (SCS) for secondary peritonitis. Methods: Between January 2014 and December 2020, 497 patients underwent SCS for secondary peritonitis, of whom 187 received a primary reconstruction of the lower gastro-intestinal tract without a diverting stoma. In 47 (25.1%) patients postoperative leakage of the enteric sutures was directly confirmed during revision surgery or by computed tomography. Quantifiable predictors of intestinal suture outcome were detected by multivariate analysis. Results: Length of intensive care, in-hospital mortality and failure of release to the initial home environment were significantly higher in patients with enteric suture leakage following SCS compared to patients with intact anastomoses (p < 0.0001, p = 0.0026 and p =0.0009, respectively). Reduced serum choline esterase (sCHE) levels and a high extent of peritonitis were identified as independent risk factors for insufficiency of enteric sutures placed during emergency laparotomy. Conclusions: A preoperative sCHE < 4.5 kU/L and generalized fecal peritonitis associate with a significantly higher incidence of enteric suture insufficiency after primary reconstruction of the lower gastro-intestinal tract in a peritonitic abdomen. These parameters may guide surgeons when choosing the optimal surgical procedure in the emergency setting. [ABSTRACT FROM AUTHOR]

Introduction: Secondary peritonitis develops as a result of GI rupture. Secondary peritonitis is one of the common causes of emergency surgical admissions with significant associated mortality and morbidity. The mortality rates vary from 12 to 41% and the primary treatment in most cases requires source control with surgical intervention. Previous studies in Indian population stated that MPI based system is often advantageous over other scoring systems for better management of the disease, patient segregation, prognostic reliability and specificity. Hence, we set out to assess and compare the discriminative ability of Mannheim peritonitis index (MPI) for in-hospital mortality of patients diagnosed with secondary peritonitis in a tertiary centre. Methodology: A hospital-based prospective study was done in 100 adult patients, diagnosed with secondary peritonitis during September 2021 to September 2022. Institutional ethical committee clearance and patients informed consent was obtained. The patients will be allotted points according to MPI scoring systems which is an 8-parameter scale, outcome assessed was 30-day mortality. An analysis was performed using SPSS version 22, Chisquare statistic was used. The receiver operating characteristic (ROC) curves were plotted with sensitivity against 1-specificity and diagnostic accuracy of MPI to assess 30-day mortality was calculated. P <0.05 was considered as significant statistically. Results: Majority belonged to the age group of 21-30years (35%), followed by 41-50 years (28%). Commonest site of perforation was duodenum in 42% followed by ileum in 27%. 30-day mortality was seen in 8% patients. The risk of mortality was highest in patients with MPI score >29(22.2%) when compared to patients with MPI score 21-29 (10%) and <21 (1.9%) and this difference was significant statistically. Conclusion: A bimodal distribution was noted with peaks in age groups of 21-30 (35%) and 41-50 (28%). Most common in males (77%). Commonest site of perforation was duodenum in 42% followed by ileum in 27%. Mortality was seen in 8%. The AUC for MPI score to assess mortality was 0.917 which shows an excellent performance in predicting mortality with score >29 as cut off. Sensitivity and specificity of MPI score with 29 as cutoff in predicting mortality was 82.3% and 76.5% with diagnostic accuracy of 85.1%. [ABSTRACT FROM AUTHOR]

Background: The management of patients with secondary peritonitis remains a great surgical challenge. Both open abdomen (OA) and primary closure (PC) approaches have been described after adequate source control with conflicting results regarding which technique is better. With the lack of Egyptian studies regarding that perspective, we conducted the present trial to compare the OA and PC approaches in patients with secondary peritonitis scheduled for emergency laparotomy. Methods:We enrolled 318 patients in this prospective trial: 156 patients in the OA group and 162 cases in the PC group. Results: All preoperative parameters expressed no significant differences between the OA and PC groups. However, after the procedure, there was a significant rise in intraabdominal pressure in the latter group (26.15 vs. 20.47 mmHg in the other group). Additionally, the compartmental syndrome was frequently encountered in the PC group. The incidence of postoperative complications was comparable between the two groups, apart from wound infection, which increased significantly in the OA group. The hospitalization period also increased in the OA group due to the need for definite abdominal closure. Moreover, mortality was significantly higher in the OA group (28.8% vs. 19.1% in the PC group). Nonetheless, the etiology of mortality did not differ between the two approaches. Conclusion:Both primary OA and PC are valid options for the management of patients undergoing emergency laparotomy. However, every approach has its pros and cons. The risks and benefits of each approach should be weighted according to patient and disease criteria. [ABSTRACT FROM AUTHOR]

Background: Rapid and accurate diagnosis of septic peritonitis is critical for initiating appropriate medical and surgical management. Objectives: The aim of this study was to determine the diagnostic utility of the total nucleated cell count (TNCC), absolute neutrophil count, neutrophil percentage, and total protein (TP) to distinguish septic versus non‐septic peritoneal effusions in dogs. Methods: Electronic medical records were retrospectively searched for peritoneal fluid samples from 2008 to 2018 and classified as septic or non‐septic based on bacterial culture and/or cytology results. Receiver operator characteristic curves (ROCs) were used to describe the overall diagnostic utility of each test, with optimal cutpoints analyzed to dichotomize continuous variables. Positive and negative likelihood ratios were calculated at these cutpoints. Results: A total of 166 unique samples, including 87 septic and 79 non‐septic peritoneal effusions, were included. There were no significant differences in dog sex, age, or days hospitalized between groups. Septic effusions had significantly higher TP, TNCC, absolute neutrophil count, and neutrophil percentage compared with non‐septic effusions. The area under the curve of the ROC curves was TNCC (0.80), absolute neutrophil count (0.80), neutrophil percentage (0.64), and TP (0.63). For TNCC and absolute neutrophil count, optimal cutoffs were 17.13 × 103 cells/μL and 19.88 × 103 cells/μL, resulting in positive and negative likelihood ratios of 2.39 and 0.28 and 2.85 and 0.28, respectively. Conclusions: Total nucleated cell counts and absolute neutrophil counts aid in the differentiation of septic and non‐septic peritoneal effusions with similar diagnostic utility but are not sufficiently sensitive or specific to use without concurrent microscopic evaluation. [ABSTRACT FROM AUTHOR]

The aim of the work is to study the changes in indices of non-specific resistance and cytokine regulation, relevant for the early diagnosis of secondary peritonitis. During the period 2016-2022, in the Surgery Department of the Communal Non-Profit Enterprise “Regional Clinical Hospital, Ivano-Frankivsk Regional Council” there were treated 192 patients with postoperative peritonitis. Of them, in 69 (35.9%) patients the changes in indices of non-specific resistance and cytokine regulation were studied. These studies were performed in the laboratory of the Department of Biological and Medical Chemistry of the Ivano-Frankivsk National Medical University. The content of CD3+-lymphocytes in the blood of patients with secondary peritonitis on admission to the hospital was 35.49±3.39%, which is 1.8-fold less than in the comparison group (p

Abstract Background The understanding of high mortality associated with intra-abdominal candidiasis (IAC) remains limited. While Candida is considered a harmless colonizer in the digestive tract, its role as a true pathogen in IAC is still debated. Evidence regarding Candida virulence in the human peritoneal fluid are lacking. We hypothesized that during IAC, Candida albicans develops virulence factors to survive to new environmental conditions. The objective of this observational exploratory monocentric study is to investigate the influence of peritoneal fluid (PF) on the expression of C. albicans virulence using a multimodal approach. Materials and methods A standardized inoculum of a C. albicans (3.106 UFC/mL) reference strain (SC5314) was introduced in vitro into various PF samples obtained from critically ill patients with intra-abdominal infection. Ascitic fluids (AFs) and Sabouraud medium (SBD) were used as control groups. Optical microscopy and conventional culture techniques were employed to assess the morphological changes and growth of C. albicans. Reverse transcriptase qPCR was utilized to quantify the expression levels of five virulence genes. The metabolic production of C. albicans was measured using the calScreener™ technology. Results A total of 26 PF samples from patients with secondary peritonitis were included in the study. Critically ill patients were mostly male (73%) with a median age of 58 years admitted for urgent surgery (78%). Peritonitis was mostly hospital-acquired (81%), including 13 post-operative peritonitis (50%). The infected PF samples predominantly exhibited polymicrobial composition. The findings revealed substantial variability in C. albicans growth and morphological changes in the PF compared to ascitic fluid. Virulence gene expression and metabolic production were dependent on the specific PF sample and the presence of bacterial coinfection. Conclusions This study provides evidence of C. albicans virulence expression in the peritoneal fluid. The observed variability in virulence expression suggests that it is influenced by the composition of PF and the presence of bacterial coinfection. These findings contribute to a better understanding of the complex dynamics of intra-abdominal candidiasis and advocate for personalized approach for IAC patients. Trial registration https://clinicaltrials.gov/ (NCT05264571; February 22, 2022) Graphical Abstract

Abstract Background Intestinal resection and a proximal stoma is the preferred surgical approach in patients with severe secondary peritonitis due to perforation of the small intestine. However, proximal stomas may result in significant nutritional problems and long-term parenteral nutrition. This study aimed to assess whether primary anastomosis or suturing of small intestine perforation is feasible and safe using the open abdomen principle with vacuum-assisted abdominal closure (VAC). Methods Between January 2005 and June 2018, we performed a retrospective chart review of 20 patients (> 18 years) with diffuse faecal peritonitis caused by small intestinal perforation and treated with primary anastomosis/suturing and subsequent open abdomen with VAC. Results The median age was 65 years (range: 23–90 years). Twelve patients were female (60%). Simple suturing of the small intestinal perforation was performed in three cases and intestinal resection with primary anastomosis in 17 cases. Four patients (20%) died within 90-days postoperatively. Leakage occurred in five cases (25%), and three patients developed an enteroatmospheric fistula (15%). Thirteen of 16 patients (83%) who survived were discharged without a stoma. The rest had a permanent stoma. Conclusions Primary suturing or resection with anastomosis and open abdomen with VAC in small intestinal perforation with severe faecal peritonitis is associated with a high rate of leakage and enteroatmospheric fistula formation. Trial registration The study was approved by the Danish Patient Safety Authority (case number 3-3013-1555/1) and the Danish Data Protection Agency (file number 18/28,404). No funding was received.

This article presents a comparative study on the outcomes of secondary peritonitis in different regions of India using the Mannheim peritonitis index (MPI). The study found that factors such as age, gender, and site of perforation were correlated with mortality rates. The study suggests that the MPI scoring system is effective in predicting risk and recommends aggressive resuscitation and intensive care support for patients with a high MPI score. The article also discusses the prevalence of upper gastrointestinal tract perforations in the Indian population and the importance of early presentation and proper management. [Extracted from the article]

Background: The understanding of high mortality associated with intra-abdominal candidiasis (IAC) remains limited. While Candida is considered a harmless colonizer in the digestive tract, its role as a true pathogen in IAC is still debated. Evidence regarding Candida virulence in the human peritoneal fluid are lacking. We hypothesized that during IAC, Candida albicans develops virulence factors to survive to new environmental conditions. The objective of this observational exploratory monocentric study is to investigate the influence of peritoneal fluid (PF) on the expression of C. albicans virulence using a multimodal approach. Materials and methods: A standardized inoculum of a C. albicans (3.106 UFC/mL) reference strain (SC5314) was introduced in vitro into various PF samples obtained from critically ill patients with intra-abdominal infection. Ascitic fluids (AFs) and Sabouraud medium (SBD) were used as control groups. Optical microscopy and conventional culture techniques were employed to assess the morphological changes and growth of C. albicans. Reverse transcriptase qPCR was utilized to quantify the expression levels of five virulence genes. The metabolic production of C. albicans was measured using the calScreener™ technology. Results: A total of 26 PF samples from patients with secondary peritonitis were included in the study. Critically ill patients were mostly male (73%) with a median age of 58 years admitted for urgent surgery (78%). Peritonitis was mostly hospital-acquired (81%), including 13 post-operative peritonitis (50%). The infected PF samples predominantly exhibited polymicrobial composition. The findings revealed substantial variability in C. albicans growth and morphological changes in the PF compared to ascitic fluid. Virulence gene expression and metabolic production were dependent on the specific PF sample and the presence of bacterial coinfection. Conclusions: This study provides evidence of C. albicans virulence expression in the peritoneal fluid. The observed variability in virulence expression suggests that it is influenced by the composition of PF and the presence of bacterial coinfection. These findings contribute to a better understanding of the complex dynamics of intra-abdominal candidiasis and advocate for personalized approach for IAC patients. Trial registrationhttps://clinicaltrials.gov/ (NCT05264571; February 22, 2022) Highlights: This study is the first to demonstrate the expression of Candida albicans virulence in human peritoneal fluid. The expression of Candida albicans virulence in peritoneal fluid shows significant variability among critically ill patients with intra-abdominal infection. The composition of peritoneal fluid and bacterial coinfection may influence the expression of Candida albicans virulence. These findings emphasize the imperative to reevaluate the delineation of intra-abdominal candidiasis, with due consideration to the virulence expression exhibited by isolated Candida. [ABSTRACT FROM AUTHOR]

Background: Intestinal resection and a proximal stoma is the preferred surgical approach in patients with severe secondary peritonitis due to perforation of the small intestine. However, proximal stomas may result in significant nutritional problems and long-term parenteral nutrition. This study aimed to assess whether primary anastomosis or suturing of small intestine perforation is feasible and safe using the open abdomen principle with vacuum-assisted abdominal closure (VAC). Methods: Between January 2005 and June 2018, we performed a retrospective chart review of 20 patients (> 18 years) with diffuse faecal peritonitis caused by small intestinal perforation and treated with primary anastomosis/suturing and subsequent open abdomen with VAC. Results: The median age was 65 years (range: 23–90 years). Twelve patients were female (60%). Simple suturing of the small intestinal perforation was performed in three cases and intestinal resection with primary anastomosis in 17 cases. Four patients (20%) died within 90-days postoperatively. Leakage occurred in five cases (25%), and three patients developed an enteroatmospheric fistula (15%). Thirteen of 16 patients (83%) who survived were discharged without a stoma. The rest had a permanent stoma. Conclusions: Primary suturing or resection with anastomosis and open abdomen with VAC in small intestinal perforation with severe faecal peritonitis is associated with a high rate of leakage and enteroatmospheric fistula formation. Trial registration: The study was approved by the Danish Patient Safety Authority (case number 3-3013-1555/1) and the Danish Data Protection Agency (file number 18/28,404). No funding was received. [ABSTRACT FROM AUTHOR]

The aim of the work is to study the changes in indices of non-specific resistance and cytokine regulation, relevant for the early diagnosis of secondary peritonitis. During the period 2016-2022, in the Surgery Department of the Communal Non-Profit Enterprise “Regional Clinical Hospital, Ivano-Frankivsk Regional Council” there were treated 192 patients with postoperative peritonitis. Of them, in 69 (35.9%) patients the changes in indices of non-specific resistance and cytokine regulation were studied. These studies were performed in the laboratory of the Department of Biological and Medical Chemistry of the Ivano-Frankivsk National Medical University. The content of CD3+-lymphocytes in the blood of patients with secondary peritonitis on admission to the hospital was 35.49±3.39%, which is 1.8-fold less than in the comparison group (p<0.002), with their subsequent drop up to 31.00±2.88% (p<0.002) during the third day of the disease. When determining CD4+-lymphocytes during the first day of observation, their indices were 21.49±3.11%, by 56% less than in the comparison group (p<0.002). During the third day of the disease, we observed a slight increase in this index – up to 23.90±3.26% (p<0.01). The study of the level of CD8+-lymphocytes showed that, on admission to the hospital, their level in blood serum was 13.92±1.05%, which is 1.6-fold lower than in patients of the comparison group (p<0.002). Their decrease was observed further, and during the third day this index was 8.08±2.28% (p<0.002). The content of CD11a+- cells on hospitalization was 11.32±0.54%, which is more than 6-fold less than in the comparison group (p<0.002). The content of CD162+-cells in the blood on hospitalization was 21.49±3.11%, which is 3.1-fold less than in the comparison group (p<0.002). The content of CD16+-cells in the blood on hospitalization was 10.83±0.87% (p<0.002). A significant increase in the content of IL in the blood serum at the initial stage of secondary peritonitis with subsequent pathological changes are contributing factors in the disorder of the body’s immune response. The content of IL-6 on admission was 759.72±28.06%, which is almost 3.4-fold higher than the indices in the comparison group (p<0.002). After surgery, this index gradually decreased and during the seventh day was 438.63±19.84% (p<0.002). The results obtained on such indices of non-specific resistance and cytokine regulation as CD3+, CD4+, CD8+, CD11a, CD162, CD95, CD16, HLADR+, IL-2, IL-4, IL-6 showed their significant differences between the subgroups studied (p<0.002), indicating their high sensitivity for diagnosing and predicting the development of secondary peritonitis. [ABSTRACT FROM AUTHOR]

Background: Secondary postoperative diffuse peritonitis (SPDP) is one of the most severe complications of elective and emergency surgical interventions associated with a high mortality rate. To date, no optimal tactics of surgical treatment of SPDP has been developed.Objective: The analysis of independent predictors of outcome depending on the method of surgical treatment – relaparotomy ondemand (RD) or vacuum-assisted laparostomy (VAL).Material and methods: The study included 141 adult patients, male and female in the period from January 2014 to December 2020: group I (n = 63) – patients who received VAL method; group II (n = 78) – RD method. The method of multivariate logistic regression analysis was used to calculate the independent effects of potential predictor variables on the treatment outcome.Results: The following independent predictors of treatment outcome in the RD group were identified: age, duration of hospital stay, number of relaparotomies, APACHE II score, Björck classification grade 1C at the 1st sanitation, bacteremia, Clavien–Dindo complications class 3a and 4a. For the VAL group: conversion of surgical tactics and bacteremia.Conclusion: In patients with SPDP in the presence of risk factors for unfavorable outcomes, the use of VAL with staged sanitation of the abdominal cavity is indicated.

Ascitic fluid infection is a serious complication of liver cirrhosis. The distinction between the more common spontaneous bacterial peritonitis (SBP) and the less common secondary peritonitis in patients with liver cirrhosis is crucial due to the varying treatment approaches. This retrospective multicentre study was conducted in three German hospitals and analysed 532 SBP episodes and 37 secondary peritonitis episodes. Overall, >30 clinical, microbiological, and laboratory parameters were evaluated to identify key differentiation criteria. Microbiological characteristics in ascites followed by severity of illness and clinicopathological parameters in ascites were the most important predictors identified by a random forest model to distinguish between SBP and secondary peritonitis. To establish a point-score model, a least absolute shrinkage and selection operator (LASSO) regression model selected the ten most promising discriminatory features. By aiming at a sensitivity of 95% either to rule out or rule in SBP episodes, two cut-off scores were defined, dividing patients with infected ascites into a low-risk (score ≥ 45) and high-risk group (score < 25) for secondary peritonitis. Overall, the discrimination of secondary peritonitis from SBP remains challenging. Our univariable analyses, random forest model, and LASSO point score may help clinicians with the crucial differentiation between SBP and secondary peritonitis. [ABSTRACT FROM AUTHOR]

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Abstract Background Secondary peritonitis is a severe condition with a 20–32% reported mortality. The accepted treatment modalities are vacuum-assisted closure (VAC) or primary closure with relaparotomy on-demand (ROD). However, no randomised controlled trial has been completed to compare the two methods potential benefits and disadvantages. Methods This study will be a randomised controlled multicentre trial, including patients aged 18 years or older with purulent or faecal peritonitis confined to at least two of the four abdominal quadrants originating from the small intestine, colon, or rectum. Randomisation will be web-based to either primary closure with ROD or VAC in blocks of 2, 4, and 6. The primary endpoint is peritonitis-related complications within 30 or 90 days and one year after index operation. Secondary outcomes are comprehensive complication index (CCI) and mortality after 30 or 90 days and one year; quality of life assessment by (SF-36) after three and 12 months, the development of incisional hernia after 12 months assessed by clinical examination and CT-scanning and healthcare resource utilisation. With an estimated superiority of 15% in the primary outcome for VAC, 340 patients must be included. Hospitals in Denmark and Europe will be invited to participate. Discussion There is no robust evidence for choosing either open abdomen with VAC treatment or primary closure with relaparotomy on-demand in patients with secondary peritonitis. The present study has the potential to answer this important clinical question. Trial Registration The study protocol has been registered at clinicaltrials.gov (NCT03932461). Protocol version 1.0, 9 January 2022.

INTRODUCTION. The main component of the treatment of patients with secondary diffuse peritonitis is surgical intervention aimed at controlling the source of infection. In some cases, a single intervention is not enough for effective sanation of the abdominal cavity, which requires relaparotomy. There is currently no generally accepted approach to the timing and order for such interventions. The OBJECTIVE was to carry out a comparative analysis of the immediate results of patients with secondary diffuse peritonitis treatment using strategies of planned and «on-demand» relaparotomies.METHODS AND MATERIALS. The inclusion criteria for the review were randomized and cohort controlled trials comparing the efficacy of planned and «on-demand» relaparotomies in the treatment of secondary diffuse peritonitis. Primary sources comparing the results of these surgical strategies in adult patients were searched using the CENTRAL, MEDLINE, Scopus and eLibrary databases. The studies were independently assessed for inclusion by two review authors according to the stated eligibility criteria followed by data extraction. The methodological quality of randomized trials was assessed using the Cochrane tool for assessing the risk of bias, nonrandomized ones – using the Russian version of the Newcastle-Ottawa scale. Arising disagreements were resolved through discussions.RESULTS. The review included one randomized controlled trial according to the inclusion criteria and 16 nonrandomized cohort studies with a total of 3672 participants (1835 and 1837 patients undergoing planned and «on-demand» relaparotomies, respectively). Given the significant statistical heterogeneity of the included studies (χ2=119.2, df=16, p

Background. Secondary postoperative diffuse peritonitis (SPDP) associates with a high incidence of abdominal sepsis and 35–92% mortality rate. An optimal surgical doctrine in this complication in lacking to date.Objectives. An efficacy assessment of vacuum-assisted laparostomy (VAL) with staged lavage relative to relaparotomy on demand (RD) in SPDP patients.Methods. Patient enrolment and analyses were conducted within period 01.11.2017-31.12.2020, totalling for 141 SPDP patients, 77 (54.6%) males and 64 (45.4%) females aged 64.5 (5972.7) years. Cohort I patients (n = 52) had post-abdominal-lavage VAL using Suprasorb® SNP (SNP-1 and SNP-2) equipment and consumables (Lohmann & Rauscher GmbH, Austria). Staged lavage was performed 48-72 h apart. Cohort II (n = 78) had a standard RD technique. Cohort III (n = 11) treatment included RD-to-VAL transition. The endpoint was the inpatient treatment outcome, a favourable completion or death. The additional estimated criteria were complications rate and severity (in ACCORDION-modified Clavien-Dindo classification), sepsis rate, C-reactive protein level, abdominal index dynamics, patient’s intensive-care and total-hospital lengths of stay.Results. Cohort I included 157 staged-lavage VALs, cohort II — 107 RDs, cohort III — 49 operations. The mortality rate was 3/52 (5.8%), 24/78 (30.8%) and 7/11 (63.6%) in cohorts I, II and III (respectively, p < 0.001). No difference was observed in the length of hospital stay, with a shorter intensive care stay after final abdominal closure in cohort I. Clavien — Dindo grade 3a complications were observed for 25.0% of cohort I, 60.3 and 45.5% — of cohorts II and III (respectively, p < 0.01); grade 3b complications were 0 (0%), 24.4 and 100% in cohorts I, II and III (respectively, p < 0.001; all 11 patients were reoperated). Multiple organ failure (grade 4b) was reported in 5.8, 30.8 and 63.6% of cohorts I, II and III (respectively, p < 0.001). By end of treatment, sepsis had resolved in 9/11 (81.8%) patients in cohort I, 5/24 (20.8%) and 1/6 (16.7%) — in cohorts II and III (respectively, p = 0.002).Conclusion. Programmed staged-lavage VAL is an optimal surgical treatment tactics in SPDP. Relative to RD, VAL provides a more effective management of local and systemic abdominal sepsis, lower mortality, fewer and less sever complications, shorter intensive care stays after abdominal closure.

Purpose: To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods: Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra‐abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (< 2 h), 'urgent' (2–6 h), and 'delayed' (> 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI). Results: The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value ≤ 4–55.4% for a value > 12, p < 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42–7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16–2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99–8.18]). Compared with 'emergency' source control intervention (< 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34–0.73]). Conclusion: 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome. [ABSTRACT FROM AUTHOR]

This comprehensive review of the recently published literature offers an overview of a very topical and complex healthcare problem: secondary peritonitis from multidrug-resistant pathogens, especially carbapenem-resistant Enterobacterales (CRE). Spontaneous secondary peritonitis and postsurgical secondary peritonitis are among the major causes of community- and healthcare- acquired sepsis, respectively. A large number of patients enter ICUs with a diagnosis of secondary peritonitis, and a high number of them reveal infection by CRE, P. aeruginosa or A. baumannii. For this reason, we conceived the idea to create a synthetic report on this topic including updated epidemiology data, a description of CRE resistance patterns, current strategies of antimicrobial treatment, and future perspectives. From this update it is clear that antimicrobial stewardship and precision medicine are becoming essential to fight the emergence of antimicrobial resistance and that even if there are new drugs effective against CRE causing secondary peritonitis, these drugs have to be used carefully especially in empirical therapy. [ABSTRACT FROM AUTHOR]

Abstract Background SIRS and qSOFA are two ancillary scoring tools that have been used globally, inside and outside of ICU to predict adverse outcomes of infections such as secondary peritonitis. A tertiary teaching hospital in Uganda uses SIRS outside the ICU to identify patients with secondary peritonitis, who are at risk of adverse outcomes. However, there are associated delays in decision making given SIRS partial reliance on laboratory parameters which are often not quickly available in a resource limited emergency setting. In response to the practical limitations of SIRS, the sepsis-3 task force recommends qSOFA as a better tool. However, its performance in patients with secondary peritonitis in comparison to that of SIRS has not been evaluated in a resource limited setting of a tertiary teaching hospital in a low and middle income country like Uganda. Objective To compare the performance of qSOFA and SIRS scores in predicting adverse outcomes of secondary peritonitis among patients on the adult surgical wards in a tertiary teaching hospital in Uganda. Methods This was a prospective cohort study of patients with clinically confirmed secondary peritonitis, from March 2018 to January 2019 at the Accident and Emergency unit and the adult surgical wards of a tertiary teaching hospital in Uganda. QSOFA and SIRS scores were generated for each patient, with a score of ≥2 recorded as high risk, while a score of

Background: Secondary peritonitis is a severe condition with a 20–32% reported mortality. The accepted treatment modalities are vacuum-assisted closure (VAC) or primary closure with relaparotomy on-demand (ROD). However, no randomised controlled trial has been completed to compare the two methods potential benefits and disadvantages. Methods: This study will be a randomised controlled multicentre trial, including patients aged 18 years or older with purulent or faecal peritonitis confined to at least two of the four abdominal quadrants originating from the small intestine, colon, or rectum. Randomisation will be web-based to either primary closure with ROD or VAC in blocks of 2, 4, and 6. The primary endpoint is peritonitis-related complications within 30 or 90 days and one year after index operation. Secondary outcomes are comprehensive complication index (CCI) and mortality after 30 or 90 days and one year; quality of life assessment by (SF-36) after three and 12 months, the development of incisional hernia after 12 months assessed by clinical examination and CT-scanning and healthcare resource utilisation. With an estimated superiority of 15% in the primary outcome for VAC, 340 patients must be included. Hospitals in Denmark and Europe will be invited to participate. Discussion: There is no robust evidence for choosing either open abdomen with VAC treatment or primary closure with relaparotomy on-demand in patients with secondary peritonitis. The present study has the potential to answer this important clinical question. Trial Registration: The study protocol has been registered at clinicaltrials.gov (NCT03932461). Protocol version 1.0, 9 January 2022. [ABSTRACT FROM AUTHOR]

Ascitic fluid infection is a serious complication of liver cirrhosis. The distinction between the more common spontaneous bacterial peritonitis (SBP) and the less common secondary peritonitis in patients with liver cirrhosis is crucial due to the varying treatment approaches. This retrospective multicentre study was conducted in three German hospitals and analysed 532 SBP episodes and 37 secondary peritonitis episodes. Overall, >30 clinical, microbiological, and laboratory parameters were evaluated to identify key differentiation criteria. Microbiological characteristics in ascites followed by severity of illness and clinicopathological parameters in ascites were the most important predictors identified by a random forest model to distinguish between SBP and secondary peritonitis. To establish a point-score model, a least absolute shrinkage and selection operator (LASSO) regression model selected the ten most promising discriminatory features. By aiming at a sensitivity of 95% either to rule out or rule in SBP episodes, two cut-off scores were defined, dividing patients with infected ascites into a low-risk (score ≥ 45) and high-risk group (score < 25) for secondary peritonitis. Overall, the discrimination of secondary peritonitis from SBP remains challenging. Our univariable analyses, random forest model, and LASSO point score may help clinicians with the crucial differentiation between SBP and secondary peritonitis.

Background Secondary peritonitis (SP) arises from direct contamination of the peritoneum by spillage from the gastrointestinal or urogenital tracts. Objective This research aimed to evaluate the clinical and epidemiological characteristics of patients with SP undergoing surgical management and to study potential factors associated with morbidity and mortality in a reference hospital in Eastern Venezuela. Methodology A retrospective cross-sectional study was conducted on patients aged 18 to 80 undergoing surgical treatment for SP at "Dr. Luis Razetti" University Hospital in Barcelona, Anzoátegui state, Venezuela, between January and December 2022. We calculated odds ratios to assess mortality risks based on the presence of postoperative complications. Results Analysis of 168 adult patients revealed a predominantly male population (n=110, 65.5%) with a mean age of 35.63 years (SD=14.34). Generalized peritonitis was observed in 126 cases (75%), primarily originating from the appendix (n=117, 69.6%). Postoperative complications occurred in 18 patients (10.7%); sepsis represented the most common associated complication (n=10, 43.5%). Patients with secondary peritonitis associated with acute appendicitis had a lower mortality rate (p=0.042). Additionally, laparotomy was associated with higher frequencies of complications (p=0.001) and mortality (p=0.025), while open appendectomy showed lower frequencies of complications (p=0.002) and mortality (p=0.035). Notably, patients experiencing postoperative complications had a significantly elevated risk of mortality (OR=98, 95% confidence interval = 21.74 - 441.69). Conclusion The most common source of SP was appendicular. Patients undergoing exploratory laparotomy for the management of SP had a higher frequency of complications and mortality, whereas those undergoing open appendectomy had lower rates of complications and mortality., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. "Dr Luis Razetti" University Hospital Bioethical Committee issued approval Memorandum N° 254-HULR-2021. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, González-Guaimare et al.)

Background: SIRS and qSOFA are two ancillary scoring tools that have been used globally, inside and outside of ICU to predict adverse outcomes of infections such as secondary peritonitis. A tertiary teaching hospital in Uganda uses SIRS outside the ICU to identify patients with secondary peritonitis, who are at risk of adverse outcomes. However, there are associated delays in decision making given SIRS partial reliance on laboratory parameters which are often not quickly available in a resource limited emergency setting. In response to the practical limitations of SIRS, the sepsis-3 task force recommends qSOFA as a better tool. However, its performance in patients with secondary peritonitis in comparison to that of SIRS has not been evaluated in a resource limited setting of a tertiary teaching hospital in a low and middle income country like Uganda.Objective: To compare the performance of qSOFA and SIRS scores in predicting adverse outcomes of secondary peritonitis among patients on the adult surgical wards in a tertiary teaching hospital in Uganda.Methods: This was a prospective cohort study of patients with clinically confirmed secondary peritonitis, from March 2018 to January 2019 at the Accident and Emergency unit and the adult surgical wards of a tertiary teaching hospital in Uganda. QSOFA and SIRS scores were generated for each patient, with a score of ≥2 recorded as high risk, while a score of < 2 recorded as low risk for the adverse outcome respectively. After surgery, patients were followed up until discharge or death. In-hospital mortality and prolonged hospital stay were the primary and secondary adverse outcomes, respectively. Sensitivity, specificity, PPV, NPV and accuracy at 95% confidence interval were calculated for each of the scores using STATA v.13.Results: A total of 153 patients were enrolled. Of these, 151(M: F, 2.4:1) completed follow up and were analysed, 2 were excluded. Mortality rate was 11.9%. Fourty (26.5%) patients had a prolonged hospital stay. QSOFA predicted in-hospital mortality with AUROC of 0.52 versus 0.62, for SIRS. Similarly, qSOFA predicted prolonged hospital stay with AUROC of 0.54 versus 0.57, for SIRS.Conclusion: SIRS is superior to qSOFA in predicting both mortality and prolonged hospital stay among patients with secondary peritonitis. However, overall, both scores showed a poor discrimination for both adverse outcomes and therefore not ideal tools. [ABSTRACT FROM AUTHOR]

This study is aimed at assessing the distinctive features of patients with infected ascites and liver cirrhosis and developing a scoring system to allow for the accurate identification of patients not requiring abdominocentesis to rule out infected ascites. A total of 700 episodes of patients with decompensated liver cirrhosis undergoing abdominocentesis between 2006 and 2020 were included. Overall, 34 clinical, drug, and laboratory features were evaluated using machine learning to identify key differentiation criteria and integrate them into a point-score model. In total, 11 discriminatory features were selected using a Lasso regression model to establish a point-score model. Considering pre-test probabilities for infected ascites of 10%, 15%, and 25%, the negative and positive predictive values of the point-score model for infected ascites were 98.1%, 97.0%, 94.6% and 14.9%, 21.8%, and 34.5%, respectively. Besides the main model, a simplified model was generated, containing only features that are fast to collect, which revealed similar predictive values. Our point-score model appears to be a promising non-invasive approach to rule out infected ascites in clinical routine with high negative predictive values in patients with hydropic decompensated liver cirrhosis, but further external validation in a prospective study is needed.

Pyonephrosis is an uncommon condition that is associated with suppurative destruction of the renal parenchyma. Upper urinary tract obstruction by renal stones plays an important role in its aetiology. The majority of pyonephrosis is reported to be caused by aerobic bacteria but the role of anaerobes, especially black-pigmented gram-negative anaerobes, namely, Prevotella and Porphyromonas in renal infections, remain poorly defined. In view of the rarity of the event, a case of pyonephrosis by Prevotella disiens and Escherichia coli coinfection complicated by secondary peritonitis in an obstructive uropathy patient is hereby presented. An attempt is being made to review the literature on the infective aetiologies of renal abscess with special reference to anaerobes.

Peritonitis is the inflammation of peritoneum of clinical emergency importance either in operation room or intensive care unit. Peritonitis is divided into primary, secondary, and tertiary. Primary peritonitis or spontaneous peritonitis is arises in the absence of an identifiable anatomical causes and has a low incidence on surgical intensive care units. Secondary peritonitis (SP) is the commonest peritonitis which is defined as an infection of the peritoneal cavity resulting from perforation, anastomotic disruption, ischemic necrosis, or other injuries of the gastrointestinal tract. Tertiary peritonitis can be defined as the persistence or recurrence of intra-abdominal infection with multiple organ failure and a systemic inflammatory response in an immune compromised host that develops after what was thought to be a effective attempt at primary source control. The management of tertiary peritonitis should include the provision of appropriate physiologic support, the administration of antimicrobial therapy, and operation or intervention to control the source of contamination and to decrease the bacterial load. Moreover, two crucial components must be present, which include the time period, which is 48 hours, and there must be successful surgical source control. Moreover, tertiary peritonitis remains a vital cause of hospital death mainly among patients with associated risk factors. [ABSTRACT FROM AUTHOR]

Amaç: Bu çalışmanın amacı, intestinal inflamasyonun göstergesi olan fekal calprotectin (FC) ile artmış intestinal inflamasyon ve buna bağlı artan bakteriyel translokasyon sonucu meydana gelen sirozun komplikasyonları arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntemler: Hastanemize başvuran 18 ve 80 yaş arası 156 sirotik hastadan, dışlama kriterlerine göre 64’ü çıkartıldı ve toplam 92 hasta ve benzer yaş ve cinsiyette 20 gönüllü kontrol grubu olarak çalışmaya dahil edildi. Başvuru sırasında alınan kan örneklerinden eritrosit sedimantasyon değeri (ESR), c-reaktif protein (CRP) ve beyaz küre sayımı (WBC) çalışıldı. Her hastadan ve kontrol grubundan başvurudan sonraki 24 saat içinde bir adet spot gaita örneği alındı. Çalışma grubu, sirozun evresi ilerledikçe veya komplikasyonlar meydana geldiğinde FC değerlerinin değişip değişmediğini incelemek için beş alt gruba (Child-Pugh Evre-A, Evre-B, Evre-C, hepatiks ensefalopati ve spontan bakteriyel peritonit) ayrıldı.Bulgular: Ortanca FC değerleri sirotik hastalarda 168,8 mg/kg ve kontrol grubunda 9,8 mg/kg idi ve gruplar arasındaki farklılık istatistiksel olarak anlamlıydı (p=0,039). Alt grup incelemesinde, spontan bakteriyel peritonit grubu ile diğer tüm alt gruplar arasındaki farklılıklar istatistiksel olarak anlamlıydı (p=0,002). Sirotik hastalarda FC ile ESR (r=0.439, p=0.545) veya CRP (r=0.403, p=0.321) ya da WBC sayımı (r=0.061, p=0.645) arasında korelasyon saptanmadı.Sonuç: Sirotik hastalarda FC değerleri yükselmektedir ve sistemik inflamasyon belirteçlerinden önce FC değerlerinin erken yükselmesi sayesinde, spontan bakteriyel peritonitte tanısal bir test olarak kullanılabilir.

Abstract Background The prognostic role of what a surgeon observes in the abdomen of patients with complicated intra-abdominal infection (cIAI) is largely unknown. The aim of this prospective study was to systemically analyze components of the intra-abdominal view (IAV) and their association to severe complicated intra-abdominal sepsis (SCIAS) or mortality. Methods The study cohort consisted of adult patients with cIAI. The operating surgeon filled a paper form describing the intra-abdominal view. Demographics, operative details, and preoperative physiological status were collected. Descriptive, univariate, and multivariate statistical analyses were performed, and a new score was developed based on regression coefficients. The primary outcome was a composite outcome of SCIAS or 30-day mortality, in which SCIAS was defined as organ dysfunctions requiring intensive care unit admission. Results A total of 283 patients were analyzed. The primary outcome was encountered in 71 (25%) patients. In the IAV, independent risk factors for the primary outcome were fecal or bile as exudate (odds ratio (OR) 1.98, 95% confidence interval 1.05–3.73), diffuse peritonitis (OR 2.15, 1.02–4.55), diffuse substantial redness of the peritoneum (OR 5.73, 2.12–15.44), and a non-appendiceal source of cIAI (OR 11.20, 4.11–30.54). Based on these factors, an IAV score was developed and its performance analyzed. The area under the receiver operating characteristic for the IAV score was 0.81. The IAV score also correlated significantly with several outcomes and organ dysfunctions. Conclusions The extent of peritonitis, diffuse substantial redness of the peritoneum, type of exudate, and source of infection associate independently with SCIAS or mortality. A high IAV score associates with mortality and organ dysfunctions, yet it needs further external validation. Combining components of IAV into comprehensive scoring systems for cIAI patients may provide additional value compared to the current scoring systems. Trial registration The study protocol was retrospectively registered on April 4, 2016, right after the first enrolled patient at Clinicaltrials.gov database (NCT02726932).

The aim of this study was to determine the role of IAH degrees in disease progression and the impact on mortality rate in patients operated for secondary peritonitis. IAP measurements via the urinary bladder were conducted in 112 patients before and after operations three times over 24 h. Based on IAP values, three patient groups were established: Gr-I: IAP 12–15 mmHg, Gr-II: IAP 16–20 mmHg and Gr-III and IV > 20 mmHg (single group). Intraabdominal hypertension (IAH) was observed in 82 patients (74.1%); 57.5% had IAH Gr-I, Gr-II had 30.0%, and Gr-III and Gr-IV had 12.5%. Abdominal perfusion pressure (APP) and filtration gradient (FG) before surgery were significantly different, according to IAH groups. After surgery, APP differences according to IAH groups remained significant, while we observed no significant postoperative differences in FG according to IAH groups. Before and after operations, we observed no differences between white blood cell (WBC) counts and body mass indices (BMI) amongst groups. Our study showed a significant statistical difference between groups of IAH for mean arterial pressure (MAP), urine output and fluid balance, creatinine, C-reactive protein (CRP), procalcitonin (PCT), acute physiology and chronic health evaluation II (APACHE II) mortality, sequential organ failure assessment (SOFA) mortality, multiple organ dysfunction score (MODS) mortality, index Mannheim peritonitis (IMP) mortality, and CT ratio of anteroposterior to transverse abdominal diameter (CT diameter: AP/T). Groups of APP: Gr-I APP > 60 mmHg and Gr-II APP < 60 mmHg showed a significant difference for several variables, including MAP, urine output and fluid balance, creatinine, CRP, PCT, APACHE II, SOFA, MODS and IMP mortality, FG, APP and CT diameter: AP/T. For WBC counts in groups, we observed no significant differences. Measuring IAP and determination of the degrees of IAH and values of APP were of great importance for the placement of further steps for the treatment of patients with secondary peritonitis. [ABSTRACT FROM AUTHOR]

Background: Damage control surgery (DCS) with open abdominal management (OAM) has been increasingly expanded to include critically ill non-trauma patients. However, there is limited data regarding the usefulness of this protocol for the treatment of severe perforative peritonitis (PP), especially with septic shock (SS). Here, we retrospectively evaluated the usefulness of our OAM protocol for PP with SS. Methods: We retrospectively reviewed patients with from June 2015 to September 2018. The proposed protocol was composed of the following steps: (1) rapid control of contamination; (2) temporary abdominal closure; (3) repeated washout of the abdominal cavity; and (4) delayed definitive surgery. For temporary abdominal closure, a negative pressure wound therapy device was used. The end points were the morbidity and 30-day mortality rates. Logistic backward regression was performed to identify factors associated with complications. Results: The mortality rate was 4% (1/25) and the overall morbidity rate of surviving patients was 58.3% (14/24). The mean duration of the first DCS was 67.36 ± 22.83 min. The median durations of ventilation and intensive care unit stay were 5 and 7 days, respectively. Although not significant, morbidity might be associated with age, diabetes mellitus, initial operative time, and OAM duration. Conclusions: A standardized protocol for OAM may improve the outcomes of patients with SS due to PP. This damage control approach can be applied for the treatment of severe abdominal sepsis. [ABSTRACT FROM AUTHOR]

Background: Secondary peritonitis is the most common indication for exploratory laparotomy in India. However the etiology of perforation varies from the western world. The objective of this study is to assess the etiology, presentation, management and post-op outcome of patients operated for secondary peritonitis at our hospital. Method: Hospital based retrospective study of 50 cases of secondary peritonitis during the period of 2015-2018. Pediatric patients, primary peritonitis and anastomotic leak patients were excluded from the study. Result: Maximum number of patients were in age group of 11-30 years with male: female =4:1. Out of 50 cases the most common clinical presentation was abdominal pain in all of the patients. Most common site of perforation was peptic perforation (44%), followed by small bowel perforation (36%), appendicular perforation (10%) and colonic perforation (10%). Overall rate of complication was 25%. Conclusion: In our setup the major etiology of perforation was infective and presentation of patients immediately after first symptom and timely surgical intervention resulted in good prognosis and less post-op complications. Complications in our study were wound infection (22%), electrolyte imbalance (20%), pulmonary complication (12%), septicemia (12%), intestinal obstruction (2%), fecal fistula (2%), burst abdomen (2%) and mortality (16%). [ABSTRACT FROM AUTHOR]

Background: Intra-abdominal infection in secondary pe ritonitis drives as excessive production of inflammatory mediators and the development of systemic inflammatory response syndrome (SIRS) or sepsis. Finding a specific marker to distinguish SIRS from sepsis would be of immense clinical importance for the therapeutic approach. It is assumed that high-mobility group box 1 protein (HMGB1) could be such a marker. In this study, we examined the time course changes in the blood levels of HMGB1, C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A (SAA) in patients with secondary peritonitis who developed SIRS or sepsis. Methods: In our study, we evaluated 100 patients with diffuse secondary peritonitis who developed SIRS or sepsis (SIRS and SEPSIS group) and 30 patients with inguinal hernia as a control group. Serum levels of HMGB1, CRP PCT, and SAA were determined on admission in all the patients, and monitored daily in patients with peritonitis until discharge from hospital. Results: Preoperative HMGB1, CRP PCT and SAA levels were statistically highly significantly increased in patients with peritonitis compared to patients with inguinal hernia, and significantly higher in patients with sepsis compared to those with SIRS. All four inflammatory markers changed significantly during the follow-up. It is interesting that the patterns of change of HMGB1 and SAA over time were distinctive for SIRS and SEPSIS groups. Conclusions: HMGB1 and SAA temporal patterns might be useful in distinguishing sepsis from noninfectious SIRS in secondary peritonitis

Background This study aims to contribute to peritonitis management strategies by comparing the demographic, clinical, and laboratory characteristics of patients diagnosed with spontaneous bacterial peritonitis (SBP), peritoneal dialysis-related peritonitis (PDrP), and secondary peritonitis. Methods This study included 86 patients diagnosed with peritonitis between 2016 and 2022. Patients were categorized and compared as SBP, PDrP, and secondary peritonitis. Results SBP was diagnosed in 36% of patients, secondary peritonitis in 36% and PDrP in 28%. The mean age of patients with PDrP is 43.71 ± 14.74, which is significantly lower compared to those with SBP and secondary peritonitis (p<0.001). Patients with hypertension (HT), chronic kidney disease (CKD), and those undergoing dialysis most commonly have PDrP whereas those without HT, without CKD, and not undergoing dialysis are most often diagnosed with secondary peritonitis (p=0.002, p<0.001, p<0.001). In peritoneal fluid cultures, the growth of Gram-positive bacteria was most commonly identified in patients with PDrP, while the growth of Gram-negative bacteria was most frequently seen in patients with secondary peritonitis (p=0.018). CRP levels and sedimentation rates were found to be higher in patients with secondary peritonitis (p<0.001, p=0.003). Conclusion The distinct characteristics observed across different types of peritonitis underscore the importance of tailored approaches to diagnosis and treatment. Parameters such as CRP levels, sedimentation rates, and patient age could serve as valuable indicators in discerning between various types of peritonitis. When selecting empirical antibiotic therapy, it's crucial to consider coverage for Gram-positive pathogens in cases of PDrP and Gram-negative pathogens in secondary peritonitis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Unver Ulusoy et al.)

There is a wide variety of disease severity in patients with complicated intraabdominal infection (cIAI). The prognostic role of intraabdominal view (IAV) was recently studied, and an IAV score was introduced. The aim of this study was to analyze the associations between the preoperative levels of eight relevant circulating cytokines and IAV components, the IAV score, as well as outcome. This was a single-center prospective study. The study cohort consisted of operatively managed adult patients with a cIAI. Preoperative plasma levels of eight cytokines were determined. The operating surgeon filled a form describing IAV. Outcomes analyzed were 30-day mortality and the development of organ dysfunctions requiring intensive care unit admission. A total of 131 patients with cIAI were analyzed, 30-day mortality was 9.9% (n = 13), and 28 (21.4%) patients had postoperative organ dysfunctions. All components of IAV, the IAV score, and outcomes were associated with various cytokine levels. Interleukin-8 was the most competent marker associating with all the variables assessed in this study: diffuse peritonitis (P < 0.001), substantial diffuse redness (P = 0.012), substantial diffuse fibrin (P = 0.003), fecal or bile as exudate (P = 0.001), nonappendiceal source of infection (P < 0.001), IAV Score groups (P < 0.001), organ dysfunctions (P < 0.001), and 30-day mortality (P = 0.035). Various cytokines associate with the IAV and outcome. IL-8 showed the best overall performance. The results emphasize the role of the surgeons' perception of the IAV. IAV provides an approximation of the magnitude of the systemic inflammatory response. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to investigate the relationship between fecal calprotectin (FC) which is a marker for intestinal inflammation and complications of cirrhosis which are due to increased bacterial translocation and intestinal inflammation. Material and Methods: Out of 156 cirrhotic patients aged between 18-80 years who are admitted to our hospital, 64 were excluded according to exclusion criteria and a total of 92 patients, and 20 volunteers with similar age and sex as a control group were included in this study. Serum samples were taken at admission to measure erythrocyte sedimentation rate (ESR), c-reactive protein (CRP) and white blood cell count (WBC). All patients and the control group provided a single stool sample within 24 hours after admission. The study group divided into five subgroups (Child-Pugh Grade A, Grade-B, Grade-C, spontaneous bacterial peritonitis and hepatic encephalopathy) to investigate whether FC levels change as the disease progress or complications occur. Results: Median FC levels were 168.8 mg/kg for cirrhotic patients and 9.8 mg/kg for control group, and the difference between the groups was statistically significant (p=0.039). In the subgroup analysis, the differences between spontaneous bacterial peritonitis and all other subgroups were statistically significant (p=0.002). In cirrhotic patients, FC levels were not correlated either with ESR (r=0.439, p=0.545) or CRP (r=0.403, p=0.321) or WBC count (r=0.061, p=0.645). Conclusion: FC levels are increased in cirrhotic patients and early increase in FC levels before the rise of systemic inflammation markers can be used as a diagnostic marker for spontaneous bacterial peritonitis. [ABSTRACT FROM AUTHOR]

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