Treatment of generalized suppurative peritonitis

: In the period from 1980 to 1986 fifty-nine patients were treated for generalized purulent peritonitis of 72-hour duration. The traditional methods of therapy were applied--removal of the source of peritonitis and drainage of the abdominal cavity. The mortality was 62.7%. Since 1987, peritoneal lavage with enteral administration of oxygenized 5% glucose solution is used in the treatment of patients with generalized peritonitis in the stage of poly-organic insufficiency. Peritoneal-enteral lavage was applied in the management of 41 patients, 10 of them died. The mortality was 36.5%. The efficacy of the method was judged on basis of bacteriological study, electroenterography, and functional tests for the absorptive capacity of the small intestine. The results of stage peritoneal lavage and the findings of bacteriological study lead to the conclusion that it is extremely dangerous to postpone repeated cleansing of the abdominal cavity in such patients because progressive deterioration of the condition with a fatal outcome occurs in this case. Cleansing of the abdominal cavity must be accomplished during the first lavage or 24 hours later during relaparotomy and no hope should be entertained that inadequate cleansing will be compensated for during subsequent relaparotomies.