Surgical management of diffuse peritonitis complicating obstetric/gynecologic infections.
A retrospective review of 176 women undergoing surgery for diffuse peritonitis secondary to pelvic infections from 1972 to 1976 was conducted. Mortality with septic abortion was 27.3% (12 of 44), with pelvic inflammatory disease 7.1% (eight of 113), and with puerperal sepsis 6.7% (one of 15). Overall mortality was 13.1% (23 of 176). Mortality was lower (P less than .05) with surgery within 24 hours (7.5%, six of 80) than after 24 hours (17.7%, 17 of 96). Mortality was lower (P less than .01) with specific antianaerobic antibiotics (zero of 36) than without (16.4%, 23 of 140). Mortality was 21.3% with hysterectomy (ten of 47) and 10.1% (13 of 129) with conservative surgery, however hysterectomy was usually performed in the more severe cases (septic abortion 75%, puerperal sepsis 66%, pelvic inflammatory disease 3%). Mortality declined from 17.6% in 1972 to 1974 (21 of 119) to 3.5% in 1975 to 1976 (two of 57). Significant differences between the two periods included an increased use of specific antianaerobic antibiotics (8.4%/45.5%) and an increased incidence of early surgery (35.3%/66.6%) in the latter years. This series emphasizes the overriding importance of early surgery and the need for the inclusion of specific antianaerobic antibiotic agents in the chemotherapeutic regimen.
D000031:Abortion, Septic / Q000150:complications / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001421:Bacteria, Anaerobic; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000401:mortality; D007813:Laparotomy; D000292:Pelvic Inflammatory Disease / Q000150:complications / Q000601:surgery*; D010538:Peritonitis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011247:Pregnancy; D011645:Puerperal Infection / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013019:South Africa; D007507:Therapeutic Irrigation; D013997:Time Factors
D000900:Anti-Bacterial Agents