Pathogenic aspects of widespread peritonitis, determining treatment policy

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

The article discusses the main aspects of the pathogenesis of peritonitis, determining treatment policy with a focus on the role of enteral insufficiency and increased intra-abdominal pressure. Analyzed the effect of increased intra-abdominal pressure on the morphological changes in the tissues of the abdominal wall, diaphragm, chest and abdominal cavities. The concepts of 4intra-abdominal hypertension and its influence on the state of the lymph circulation, venous and arterial blood supply and the role of intra-abdominal hypertension, as the starting point in the development of multiple organ failure, leading to the 4intra-abdominal hypertension syndrome, which occurs in 16% of patients with widespread peritonitis. Methods of correction intra-abdominal hypertension discusses the role of the nazointestinal decompression, epidural anesthesia, laparostomy with dosage correction of intra­abdominal pressure. It is shown that the decompression of the abdomen is the only way to treat the «intra-abdominal hypertension syndrome», which leads to a decrease in mortality in peritonitis.

Key words: widespread peritonitis, abdominal perfusion pressure, intra-abdominal pressure, syndrome of intra-abdominal hypertension.

Contact: Y.V. Grebtcov Tel. 8-911-934-05-51 e-mail: Grebcov_dok@mail.ru