Peritonitis drainage procedures

The treatment of intraabdominal infection most often requires the coordinated use of three major modalities (1) prompt drainage, (2) support of vital functions, and (3) appropriate antimicrobial therapy to treat infection not eradicated by surgery. Antimicrobials are an important adjunct to drainage procedures in the treatment of secondary intraabdominal infections however, the use of antimicrobial agents without surgical intervention usually is inadequate. For most cases of primary peritonitis, drainage procedures may not be required, and antimicrobial agents become the mainstay of therapy. 

Antimicrobials are an important adjunct to drainage procedures in the treatment of intraabdominal infections however, the use of antimicrobial agents without surgical intervention is usually inadequate. For some specific situations (e.g., most cases of primary peritonitis), drainage procedures... 

Primary peritonitis is treated with antimicrobials and rarely requires drainage. Secondary peritonitis requires surgical removal of the inflamed or gangrenous tissue to prevent further bacterial contamination. If the surgical procedure is sub-optimal, attempts are made to provide drainage of the infected or gangrenous structures. 

Vigorous fluid resuscitation and support of respiratory, renal, cardiovascular, and hepatobiliary function may limit systemic complications. " However, there is no proven method to prevent these complications. While hemoconcentration (decreased intravascular volume) is strongly associated with pancreatic necrosis, it is not clear whether aggressive fluid resuscitation alone during the first 24 hours can prevent pancreatic necrosis." Procedures such as ERCP, hypothermia, nasogastric suction, pancreatic irradiation, peritoneal lavage, and thoracic duct drainage remain unproven. ... 

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