Authors
Levchuk A.L.1, Abdullaev A.E.2
1 Pirogov National Medical and Surgical Center, Moscow
2 GKB SMP, Vladimir
Abstract
The aim is to study the prognostic value of IBD in patients with advanced purulent peritonitis as a predictor of the development of postoperative complications and abdominal compartment syndrome.
Materials and methods. A study was conducted with the participation of 130 patients treated at the State Clinical Hospital in Vladimir from 2019–2024 with a clinical picture of widespread peritonitis. There were 72 men (55%) and 58 women (44%). The average age of the patients was 56.2±11.3 years. The degree of organ dysfunction was determined by the SOFA scale. The Mannheim Peritonitis Index (MIP) and the APACHE-II scale were used to assess the prognosis and severity of peritonitis. IAP monitoring was performed in 100% of the observations. Surgical interventions were performed in 125 (96%) cases.
Results: Based on the etiology of peritonitis, 4 groups were formed. Group 1 (n-41) (31.5%) patients with acute gangrenous-perforated appendicitis and widespread purulent peritonitis. The indicators of the integral scales ARASNE-II, SOFA, MIP, plasma lactate, C-reactive blood protein reflected the relationship between the severity of the course of intraperitoneal infection and the increase in IBD. Group 2 (n-15) (11%) is represented by patients with destructive pancreatitis. In 8 (6.1%) cases, pancreatic necrosis was alcoholic, in 7 (5.3%) biliary pancreatitis. The results of the study of IBD in this category of patients showed the relationship of an increase in IBD with an increase in PH on the ARASNE-II and SOFA scales, while the phenomena of a systemic inflammatory reaction increased up to the development of septic shock. Group 3 (n-53) (40%) patients with perforation of the diverticulum of the colon complicated by widespread peritonitis. Laparostomy was performed in 7 (5.3%) cases in patients with advanced fecal peritonitis. The lowest rates of IBD were in patients who underwent nasointestinal intubation of the small intestine with a Miller-Abbott probe. And in the groups of patients whose management took place with the formation of laparostomy and the use of negative pressure VAC systems, the development of compartment syndrome was not noted. Group 4 – (n-21) (16%) patients with acute adhesive small bowel obstruction. There were no fatalities. The level of IBD III and IV art. on the fifth day after surgery, was noted in 4 (3%) cases. This condition was a sign of the development of abdominal compartment syndrome.
Conclusion: Abdominal compartment syndrome is the clinical and morphological essence of peritonitis in the toxic and terminal phases of its development. Intraoperative and postoperative decompression of the stomach and intestines with intra-intestinal lavage, the use of “open” abdominal tactics, careful control over the volume and nature of infusion therapy, early application of extracorporeal detoxification methods are integral ways to prevent the development of this formidable complication of peritonitis, which should always be performed in patients of this category, regardless of etiological causes and trigger points secondary widespread peritonitis.
Keywords: acute surgical diseases of the abdominal cavity, intra-abdominal hypertension, peritonitis.
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