The same cause

The emergence of RP is directly related to the pathological process in the abdominal cavity (retroperitoneal space). In this group of patients with peritonitis occurs directly during the progression of the disease and required an operation. Criteria for choosing the semi-surgical benefits were the prevalence and severity of the inflammatory process, the effectiveness of eliminating the source of peritonitis during the operation, the quantitative and qualitative bacteriological characteristics of the exudate of the abdominal cavity, and the timing of the pathological process in the stomach and overall assessment of the severity of organ failure (IIP APACHE II) [Ermolov AS, 1996, Fedorov VD, 2000; Shurkalin BK, 2000]. Although deaths were recorded, was not obtained objective data for the progression of inflammation of the peritoneum after surgery and cause of death can be regarded as failure of the function of organs and systems, had primary and not related to the erroneous actions of a surgeon.

2.Vozniknovenie peritonitis has the same cause, but in the course of a comprehensive assessment of the severity of peritonitis, according to the above criteria, it is stated its progressive course, the likelihood of relief in which one operation is in doubt. This defines the active surgical treatment, defined as the half-open method of treatment. Over the next 24 - 36 hours done Milestone remedial relaparotomy (ESR) using organo-complex resuscitation measures (hereinafter referred to JWC), and if it was necessary (for the same reasons) ESR + JWC was repeated until the final renovation of the abdominal cavity as a source of abdominal sepsis . In this group of patients with progression of widespread peritonitis was not related to the quality of execution of the first operational benefits, delayed surgery, wrong intraopreratsionnoy tactics, ie, completely absent from the human factor as a factor influencing the prognosis of the disease.

3.Vozniknovenie RP after planned operations or after an emergency operation brand viagra in which peritonitis was not diagnosed, or he had a regional distribution. Underlying causes of the progression (or occurrence) of peritonitis were either technical errors (leaking joints, lack of sanitation of the abdominal cavity, poor hemostasis, traumatic manipulation), or the imperfection of the immune response (local and general), the underestimation of the virulence of the microflora, lack of prevention of infection. Conventionally, this group of patients can be divided into two subgroups.

3.1.Peritonit dominated iatrogennogo factor for development.

3.2.Peritonit etiologically associated with immunodeficiency.

Treatment of patients in this group after the diagnosis of widespread peritonitis can be made semi-closed or semi-open way.

4.U patients of this group of ER occurred at admission, however, during the operation the degree of its prevalence, type and amount of exudate, the state of suffering (not remote) body weight of organ failure were not evaluated properly and treated with half-closed manner. As a result, after 12 - 96 hours (and sometimes later) was marked by the progression of clinical peritonitis, which required relaparotomy, sometimes expand the volume of the previous operation. Peritonitis in this group of patients often etiologically related to the quality of operational manuals and intraoperative tactics. The role of secondary immunodeficiency in the development of purulent infection in these patients objectively proved, but the interaction of the components of the immune response is still being discussed. These two factors define the two basic directions in the diagnosis of the progression of RP, which can not be fully considered as postoperative.

Among the reasons for the progression of RP were: leaky seams of the hollow body, an erroneous estimate of the prevalence of peritonitis, an erroneous evaluation of the reorganization of the abdominal cavity, faulty intraoperative diagnosis, erroneous assessment of the consistency of the walls of the hollow body, poor drainage (or lack thereof), poor hemostasis, traumatic manipulation in the abdominal cavity, the underestimation of the virulence of microorganisms, inadequate prevention of infection.

Mortality in the first group, amounting to 10,1% outlines the range of patients whose treatment is likely, should have been held semi-open way. Inertia in the event of the first signs of organ dysfunction on the background is not the most powerful antibiotic therapy led to the development nekurabilnogo state, the development of thromboembolic complications. Correct choice of semi-open fashion and was not absolute. As it turned out, more attention was paid to the character of exudate, bacterial contamination, rather than the degree of endotoxemia, and organ dysfunction. I must say that the complex symptoms of systemic reactions to inflammation may occur in serous and fibrinous peritonitis and absent at a purulent. Therefore, the complete synchronization of the concepts of "peritonitis," and "sepsis" is premature. Repeated emergency intervention was done in groups III and IV in 28 and 150 hours. Late diagnosis and the high level of endotoxemia provided high mortality rate.

many years
myocardial infarction
topical ointment
baroreflex activity
endocrine function