Ongoing Peritonitis (Tertiary Peritonotis)

Peritonitis is a major killer in practice of clinical surgery. Over the past few decades, the mortality of severe secondary peritonitis (SP) has markedly reduced as a result of increased knowledge of the underlying pathophysiology, aggressive surgical techniques, broad-spectrum antimicrobial agents, and advanced life-support facilities. However, the surgeon not uncommonly encounters a clinical situation in which the abdominal infection persists and multiple organ failure develops despite optimal treatment. This syndrome, so-called tertiary peritonitis (TP), is a severe recurrent or persistent intra-abdominal infection after adequate surgical control of secondary peritonitis and is associated with high mortality. There is significant difference between the microbial flora in tertiary peritonitis and secondary peritonitis and TP comprises of mostly opportunistic and nosocomial facultative pathogenic bacteria and fungi. The development of multidrug resistance has also been observed in microbes causing TP due to use of broad-spectrum antibiotic therapy.