Tertiary Peritonitis as a Challenge for Intensive Care

Abstract

Introduction: Intraabdominal infections are considered one of the leading causes of surgical emergencies worldwide. Recognition of tertiary peritonitis as a new form of sepsis of intraabdominal origin and multi-organ dysfunction and/or failure is increasing, but not unanimous.

Objective: To carry out an analysis of the literature about tertiary peritonitis, its definition, pathophysiological elements, risk factors, and therapy.

Method: A search was carried out in the databases of Pubmed, LILACS, SciELO and Google Scholar. Keywords, as well as DeCs and MESH terms were used in the search period 2010-2020, in English and Spanish, in order to provide the concepts, classifications and the comprehensive management for tertiary peritonitis. The types of studies selected were guidelines, systematic reviews, randomized clinical trials, and observational studies.

Development: The condition was defined as a peritoneal inflammation that persisted or recurred after 48 hours, with clinical signs of peritoneal irritation, after apparently adequate treatment that followed secondary peritonitis caused by nosocomial pathogens. The entity had a high mortality, with necessary elements for its diagnosis: a characteristic bacterial flora, generally low virulence microorganisms and predisposition to affect immunocompromised patients. The key elements for its treatment are antibiotic therapy and suitable surgical management.

Conclusions: Despite the extreme severity of this entity, there are ambiguities in its definition, diagnosis and managment. Studies on the subject address very heterogeneous definitions and, therefore, the outcomes are highly variable.

Keywords: intraabdominal infections; tertiary peritonitis; sepsis.