Die Insuffizienz der intraabdominellen Infektabwehr bei der eitrigen Peritonitis

Despite a high concentration of serum proteins and intact phagocytes peritonitis exudates contain a large number of viable, pathogenic bacteria. The reason for this biological paradox is unknown. Our investigations reveal a pronounced defect in humoral opsonization of foreign particles in peritonitis exudate. We evaluated a modified chemiluminescence system allowing the determination of opsonic activity in serum and exudate. In serum we found a close correlation between opsonic activity and immunologically measurable levels of C3-complement and IgG. In purulent peritonitis exudates, however, the actual opsonizing activity was much less than expected according to the opsonin concentrations. We found a pronounced difference between immunologically determined opsonin levels and impaired opsonic function. Employing crossed immunoelectrophoresis massive C3-splitting into smaller fragments could be demonstrated in peritonitis exudates. In these exudates we found very high concentrations of granulocyte proteolytic (elastase) and oxidative (myeloperoxidase) enzymes which may lead to a functional destruction of opsonins followed by impaired opsonization in peritonitis exudate. The great number of bacteria and foreign particles in addition can cause a pronounced physiological consumption of complement components. The almost complete breakdown of intact C3-complement in intraabdominal exudate explains the deficient host defence in patients with severe peritonitis

Analyse von Kolonperforationen an der Klinik für Allgemein- und Viszeralchirurgie der Friedrich-Schiller-Universität zu Jena über den Zeitraum von 1995 bis 2001

Die Kolonperforation ist eine seltene Erkrankung mit vielfältigen Ursachen. Sie kann eine Peritonitis mit konsekutiver Sepsis auslösen und geht mit einer hohen Morbidität und Mortalität einher. Ziel der vorliegenden Arbeit war eine Deskription des Patientengutes mit Kolonperforation an der Klinik für Allgemein und Viszeralchirurgie der Friedrich-Schiller-Universität Jena. Außerdem sollten die Behandlungsmöglichkeiten untersucht und Prognosefaktoren ermittelt sowie im Bezug auf die Mortalität mit der aktuellen Literatur diskutiert werden. Es erfolgte eine retrospektive Erfassung der Daten aus den Patientenakten über den Zeitraum von 1995 bis 2001. Pro Patient wurden 100 Merkmale ausgewertet. Die Datenauswertung erfolgte univariat und multivariat mit Hilfe des Programmsystems SPSS. Insgesamt 120 konsekutive Patienten wurden nach der Perforationsursache in vier Gruppen eingeteilt: Divertikulitis (43 Patienten, 36%), Maligne Tumoren (16 Patienten, 13%), Iatrogen (34 Patienten, 28%) und sonstige Ursachen (27 Patienten, 23%). Unter den 120 Patienten waren jeweils 60 Männer und Frauen. Der Altersmedian (Range) betrug 68 (26-93) Jahre

How to deal with an open abdomen?

Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open prophylactically. Apart from fluid control and protection from external injury, fluid evacuation and facilitation of early closure are now the goals of open abdomen treatment. Abdominal negative pressure therapy has emerged as the most appropriate method to reach these goals. Especially when combined with strategies that allow progressive approximation of the fascial edges, high closure rates can be obtained. Intra-abdominal pressure measurement can be used to guide the surgical strategy and continued attention to intra-abdominal hypertension is necessary. This paper reviews recent advances as well as identifying the remaining challenges in patients requiring open abdomen treatment. The new classification system of the open abdomen is an important tool to use when comparing the efficacy of different strategies, as well as different systems of temporary abdominal closure

History of the Innovation of Damage Control for Management of Trauma Patients: 1902-2016

Objective: To review the history of the innovation of damage control (DC) for management of trauma patients. Background: DC is an important development in trauma care that provides a valuable case study in surgical innovation. Methods: We searched bibliographic databases (1950-2015), conference abstracts (2009-2013), Web sites, textbooks, and bibliographies for articles relating to trauma DC. The innovation of DC was then classified according to the Innovation, Development, Exploration, Assessment, and Long-term study model of surgical innovation. Results: The innovation\u27\u27 of DC originated from the use of therapeutic liver packing, a practice that had previously been abandoned after World War II because of adverse events. It then developed\u27\u27 into abbreviated laparotomy using rapid conservative operative techniques.\u27\u27 Subsequent exploration\u27\u27 resulted in the application of DC to increasingly complex abdominal injuries and thoracic, peripheral vascular, and orthopedic injuries. Increasing use of DC laparotomy was followed by growing reports of postinjury abdominal compartment syndrome and prophylactic use of the open abdomen to prevent intra-abdominal hypertension after DC laparotomy. By the year 2000, DC surgery had been widely adopted and was recommended for use in surgical journals, textbooks, and teaching courses ( assessment\u27\u27 stage of innovation). Long-term study\u27\u27 of DC is raising questions about whether the procedure should be used more selectively in the context of improving resuscitation practices. Conclusions: The history of the innovation of DC illustrates how a previously abandoned surgical technique was adapted and readopted in response to an increased understanding of trauma patient physiology and changing injury patterns and trauma resuscitation practices

Which Surgical Strategy in Sepsis from Retro Peritoneal Colic Perforation

In the last decade, attention has been paid to severe abdominal infections which, due to their severity and difficulty in treatment, cause death in 30-60% of cases

V.A.C.® Abdominal Dressing System: A Temporary Closure for Open Abdomen

Background and Purpose:: The study reports experience with the recently commercially available V.A.C.® Abdominal Dressing System, a system designed for a temporary closure of an open abdomen situation under negative pressure. The method allows a late primary fascial closure after laparotomy in case of damage control, abdominal compartment syndrome or severe intra-abdominal spesis and facilitates delayed reconstruction of a large ventral hernia. Patients and Methods:: 18 patients with an open abdomen after laparotomy were managed between February 2002 and September 2004. Results:: Twelve patients after primary, one patient after secondary fascial closure and one patient with partially primary closure and resorbable mesh for abdominal wall reconstruction were free of wound infection or dehiscence of the abdominal wall. Evisceration or enteric fistulas were not observed. Five patients died in consequence of severe injury, a multiple organ failure or septic complications. Conclusion:: V.A.C.® Abdominal Dressing System is an effective temporary closure technique for open abdomen in critically ill patients which makes a late primary fascial closure up to 2 months after initial laparotomy possible either in trauma patients or in case of severe intraabdominal infection. The technique is simple and easily mastere

Цитологический контроль как рациональный и объективный метод в оценке тяжести перитонита и выбора хирургической тактики

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