Evaluation of sulfonamides in the treatment of peritonitis of appendiceal origin

A study was made of 903 cases of perforative appendicitis at the Los Angeles General Hospital, in order to evaluate the use of sulfonamides in the treatment of peritonitis. During the five-year period 1939 to 1940, the mortality rate for perforated appendicitis decreased from 9.2 to 3.4 per cent. Sulfonamides were used with increasing frequency so that 98 per cent of all the cases during 1942 received some form of chemotherapy. The mortality rate decreased each year as the use of sulfonamides increased. Morbidity as well as mortality was reduced as observed by the yearly decrease in the frequency of postoperative peritoneal abscesses and pneumonitis. Drainage of the peritoneal cavity following appendectomy was used less often, as sulfonamides were used intraperitoneally in nearly all cases. In 1942, one patient out of three had no drain used, either in the peritoneal cavity or abdominal wound. In abscess formation following appendiceal perforation the procedure of choice was incision and drainage only in the completely walled off abscess. In 1942, appendectomy was performed in over three-fourths of the abscess cases without fatality. Clinical observations on a large group of cases apparently confirm the experimental evidence that sulfonamides are an effective form of therapy in the treatment of peritonitis. Their use is of particular value when implanted intraperitoneally during the early stages of peritonitis in perforative appendicitis.