title: Open management of the abdomen and planned reoperations in severe bacterial peritonitis.
abstract: OBJECTIVE
  To assess the results of open management of the abdomen and planned re-operations in severe bacterial peritonitis after perforation or anastomotic disruption of the digestive tract.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University Hospital, The Netherlands.
  
  
  METHODS
  67 consecutive patients.
  
  
  METHODS
  Open management of the abdomen and planned reoperations.
  
  
  METHODS
  Hospital morbidity and mortality, long-term follow-up.
  
  
  RESULTS
  38 patients developed multiple organ failure (MOF), but 29 needed only ventilatory and inotropic support. The mean number of re-operations was nine. 16 patients developed severe bleeding and 16 fistulas. In-hospital mortality was 42% (n = 28). Long-term morbidity, particularly the number of abdominal wall defects (n = 10), was considerable.
  
  
  CONCLUSIONS
  Despite open management of the abdomen and planned re-operations, mortality of severe bacterial peritonitis still continues to be too high, and both short and long-term morbidity are appreciable. The value of open management of the abdomen and planned re-operations rests only on the clinical observation that other conventional surgical treatments of severe bacterial peritonitis often fail.
authors.affiliation: Department of Surgery, University Hospital Utrecht, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Bosscha
authors.forename: P F
authors.initials: PF
authors.lastname: Hulstaert
authors.forename: M R
authors.initials: MR
authors.lastname: Visser
authors.forename: T J
authors.initials: TJ
authors.lastname: van Vroonhoven
authors.forename: C
authors.initials: C
authors.lastname: van der Werken
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D010538:Peritonitis / Q000382:microbiology* / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative; D013997:Time Factors; D016896:Treatment Outcome