Download PDF
Allgemein- und Viszeralchirurgie up2date 2015; 9(06): 447-461
DOI: 10.1055/s-0041-107678
Allgemeine Chirurgie
Georg Thieme Verlag KG Stuttgart · New York

Peritonitis

B. M. Rau
Further Information

Publication History

Publication Date:
15 December 2015 (online)

Also available at
    Permissions and Reprints All articles of this category

Die chirurgische Herdsanierung ist obligater Bestandteil der Behandlung eines jeden Patienten mit sekundärer Peritonitis und ist in diagnostischer als auch therapeutischer Hinsicht relevant. Die Wahl des chirurgischen Verfahrens hängt von der Ursache und dem Ausmaß der zugrunde liegenden Pathologie ab und schließt laparoskopische, offene, ein- und mehrzeitige Vorgehensweisen ein. Häufig sind Ausmaß und genauer Zeitpunkt der chirurgischen Interventionen unzureichend definiert und von der Erfahrung des behandelnden Chirurgen abhängig. Die engmaschige klinische Evaluation stellt den wichtigsten Faktor für die weitere laborchemische und bildgebende Diagnostik dar. Sobald die Verdachtsdiagnose einer intraabdominellen Infektion besteht, ist eine breite Antibiotikatherapie umgehend zu beginnen. Die supportive Therapie der Sepsis ist in regelmäßig überarbeiteten Leitlinien der Surviving Sepsis Campaign international standardisiert und erfordert eine konsequente Schulung des ärztlichen und pflegerischen Personals.

 

  • Quellenangaben

  • 1 Moore LJ, Moore FA, Todd SR et al. Sepsis in general surgery: the 2005–2007 national surgical quality improvement program perspective. Arch Surg 2010; 145: 695-700
    CrossrefGoogle Scholar
  • 2 Bernard GR, Vincent JL, Laterre PF et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001; 344: 699-709
    CrossrefPubMedGoogle Scholar
  • 3 Bruch HP, Woltmann A. Peritoneum und Omentum majus. In: Lippert H, Hrsg. Praxis der Chirurgie. Allgemein- und Viszeralchirurgie. Stuttgart: Thieme; 1998: 613-627
    Google Scholar
  • 4 Sartelli M, Catena F, Ansaloni L et al. Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study. World J Emerg Surg 2012; 7: 36
    CrossrefGoogle Scholar
  • 5 [no author] American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20: 864-874
    CrossrefGoogle Scholar
  • 6 Dellinger RP, Levy MM, Rhodes A et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013; 39: 165-228
    CrossrefPubMedGoogle Scholar
  • 7 Moore LJ, Moore FA. Early diagnosis and evidence-based care of surgical sepsis. Intensive Care Med 2013; 28: 107-117
    CrossrefGoogle Scholar
  • 8 Rivers EP, Jaehne AK, Nguyen HB et al. Early biomarker activity in severe sepsis and septic shock and a contemporary review of immunotherapy trials: not a time to give up, but to give it earlier. Shock 2013; 39: 127-137
    Google Scholar
  • 9 Wacker C, Prkno A, Brunkhorst FM et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 2013; 13: 426-435
    CrossrefPubMedGoogle Scholar
  • 10 Novotny AR, Emmanuel K, Hueser N et al. Procalcitonin ratio indicates successful surgical treatment of abdominal sepsis. Surgery 2009; 145: 20-26
    CrossrefGoogle Scholar
  • 11 Bader FG, Schroder M, Kujath P et al. Diffuse postoperative peritonitis – value of diagnostic parameters and impact of early indication for relaparotomy. Eur J Med Res 2009; 14: 491-496
    CrossrefGoogle Scholar
  • 12 Wacha H, Linder MM, Feldman U et al. Mannheim peritonitis index e prediction of risk of death from peritonitis: construction of a statistical and validation of an empirically based index. Theoretical Surg 1987; 1: 169-177
    Google Scholar
  • 13 van Ruler O, Kiewiet JJ, Boer KR et al. Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy. BMC Surg 2011; 11: 38
    CrossrefGoogle Scholar
  • 14 van Ruler O, Mahler CW, Boer KR et al. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA 2007; 298: 865-872
    CrossrefGoogle Scholar
  • 15 Kirkpatrick AW, Roberts DJ, De Waele J et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 2013; 39: 1190-1206
    CrossrefGoogle Scholar
  • 16 De Waele J, De Bus L. How to treat infections in a surgical intensive care unit. BMC Infectious Diseases 2014; 14: 193-197
    CrossrefGoogle Scholar
  • 17 Coccolini F, Tranà C, Sartelli M et al. Laparoscopic management of intra-abdominal infections: Systematic review of the literature. World J Gastrointest Surg 2015; 7: 160-169
    CrossrefGoogle Scholar
  • 18 Gaertner WB, Kwaan MR, Madoff RD et al. The evolving role of laparoscopy in colonic diverticular disease: a systematic review. World J Surg 2013; 37: 629-638
    CrossrefGoogle Scholar
  • 19 Cirocchi R, Trastulli S, Vettoretto N et al. Laparoscopic peritoneal lavage: a definitive treatment for diverticular peritonitis or a “bridge” to elective laparoscopic sigmoidectomy? A systematic review. Medicine (Baltimore) 2015; 94: e334
    CrossrefGoogle Scholar
  • 20 Bodman KF, Grabein B. Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen bei Erwachsenen – update 2010. Chemother J 2010; 19: 179-255
    Google Scholar
  • 21 Kumar A, Roberts D, Wood KE et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34: 1589-1596
    CrossrefPubMedGoogle Scholar
  • 22 Levy MM, Dellinger RP, Townsend SR et al. The surviving sepsis campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med 2010; 36: 222-231
    CrossrefGoogle Scholar
  • 23 Rivers E, Nguyen B, Havstad S et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368-1377
    CrossrefPubMedGoogle Scholar