title: Secondary peritonitis - evaluation of 204 cases and literature review.
abstract: OBJECTIVE
  Even at the beginning of the new millennium, secondary peritonitis presents a common life-threatening condition associated with high mortality and morbidity.
  
  
  OBJECTIVE
  This article comments on epidemiology, diagnosis and general principles of surgical management in patients with secondary peritonitis.
  
  
  RESULTS
  The demographic data, clinical findings and surgical outcome of 204 patients who had a confirmed generalized secondary peritonitis were analyzed retrospectively. Our approach was laparotomy, surgical control of contamination, antibiotic therapy and modern intensive care support. Acid peptic disease was the most common cause of perforation peritonitis 60 (29,41%), following by the perforated appendicitis 45 ( 22,06%). The faecal peritonitis and colon perforation were found in 42 patients (20,59%). The morbidity rate was 50%; 41 (40,2%) patients had more than one complication. The morbidity rate was significantly the highest in patients with colon perforation (n=38, 90%) (Hi-square=40,1; p<0,001). The overall mortality rate in our study was 8,82%. The mortality rate was significantly the highest among the patients with mesenteric ischemia in 4 patients (66,67%), followed by colon perforation in 10 cases (23,81%), and 4(6,6%) deaths due to gastro-duodenal perforation (Hi-square=45,7; p<0,001).
  
  
  CONCLUSIONS
  This study has confirmed that the clinical presentation and outcome of the secondary peritonitis depend on duration of abdominal infection, the site of perforation and the general condition of the patient. Rapid surgical source control, modern intensive care and sepsis therapy may offer the chance of decreased morbidity and mortality of the intra-abdominal infections.
authors.affiliation: Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: S K
authors.initials: SK
authors.lastname: Doklestić
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: D D
authors.initials: DD
authors.lastname: Bajec
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: R V
authors.initials: RV
authors.lastname: Djukić
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia; Department of Anesthesiology, Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: V
authors.initials: V
authors.lastname: Bumbaširević
authors.affiliation: Health Center Novi Pazar, Serbia.
authors.forename: A D
authors.initials: AD
authors.lastname: Detanac
authors.affiliation: Health Center Novi Pazar, Serbia.
authors.forename: S D
authors.initials: SD
authors.lastname: Detanac
authors.affiliation: Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: M
authors.initials: M
authors.lastname: Bracanović
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: R A
authors.initials: RA
authors.lastname: Karamarković
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003106:Colon / Q000473:pathology; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D009017:Morbidity; D009026:Mortality; D010538:Peritonitis / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: acute abdomen; emergency surgery; secondary peritonitis