Morbimortalidad en pacientes con peritonitis apendicular sometidos a cirugía laparoscópica / Morbimortality in patients with appendicular peritonitis undergoing laparoscopic surgery

Objetivo: Describir la morbimortalidad de los pacientes con diagnóstico de peritonitis apendicular, sometidos a cirugía laparoscópica en el Servicio de Cirugía General del Hospital Universitario de Caracas, durante el periodo enero 2013 - diciembre 2018. Métodos: estudio retrospectivo, descriptivo, observacional de corte transversal. Se revisaron las historias clínicas de los pacientes con peritonitis apendicular que fueron sometidos a cirugía laparoscópica en los servicios de Cirugía I, II, III y IV del Hospital Universitario de Caracas, en el período enero 2013-diciembre 2018. Las variables cuantitativas se expresaron en media ± desviación estándar y variables cualitativas en frecuencia y porcentaje; los datos se procesaron en el programa estadístico SPSS 19 (SPSS, inc., Chicago, EEUU). Resultados: la muestra estuvo conformado por 60 pacientes con edades entre 12 y 78 años, con el 78,33% en el grupo etario de 10 a 29 años; el sexo masculino representó el 58,33% de la muestra, con un promedio de edad de 23,90± 11,84 años; las complicaciones se presentaron en el 18,33% de los casos, más frecuente la infección del sitio operatorio con 6,67% (n=4) de los pacientes. La estancia hospitalaria global fue de 4,80 ± 2,58 días. Un paciente falleció. Conclusiones: el abordaje laparoscópico para el tratamiento de la peritonitis apendicular difusa se relaciona con muy baja morbimortalidad postoperatoria. La complicación más frecuente fue la infección del sitio operatorio. La mayoría de los pacientes solo ameritó una intervención quirúrgica(AU)

Objective: To describe the morbimortality ofpatients with a diagnosis of appendicular peritonitis undegoinglaparoscopic surgery in the General Surgery Department of the University Hospital of Caracas, during the period January2013 - December 2018. Methods: A retrospective, descriptive,observational, cross-sectional, descriptive study was performed.the medical records of patients with appendicular peritonitis who underwent laparoscopic surgery in the Surgery I, II, III and IV services of the University Hospital of Caracas were reviewed. Period January 2013-December 2018. Quantitative variables are expressed as mean ± standard deviation and qualitative variablesas frequency and percentage. The data were processed in the SPSS 19 statistical program (SPSS, inc., Chicago, USA). Results: the sample consisted of 60 patients aged between 12 and 78 years, with 78.33% in the age group 10 to 29 years. Male sex represented 58.33% of the sample, with an average age of 23.90 ±11.84 years. Complications occurred in 18.33% of the cases, with6.67% (n=4) of the patients reporting surgical site infection. The overall hospital stays of 4.80 ± 2.58 days. One patientdied. Conclusions: the laparoscopic approach is of choice for the treatment of diffuse appendicular peritonitis. The most frequent complication was surgical site infection. Most of the patients only required one surgical intervention(AU)

Caracterización epidemiológica: análisis de tasa de mortalidad e índice de swaroop para peritonitis en el periodo 2017- 2021, en Chile / Epidemiological characterization: peritonitis mortality rate and swaroop Index in the period 2017 - 2021, in Chile

Introducción: La peritonitis alcanza una mortalidad global de hasta un 60%. Dada la falta de estudios epidemiológicos nacionales, se plantea calcular la tasa de mortalidad (TM) por peritonitis entre los años 2017-2021 en Chile. Metodología: Estudio descriptivo, ecológico, sobre defunciones por peritonitis entre los años 2017-2021 en Chile (N=1.741), en población mayor de 15 años según grupo etario, sexo y región con datos obtenidos del departamento de estadística e información en salud. Se utilizó estadística descriptiva, cálculo de TM e índice de Swaroop (IS). No requirió aprobación por comité de ética. Resultados: Se calculó una TM de 2,47/100.000 habitantes entre los años 2017 y 2021, siendo el año 2020 la mayor con 3,07. El sexo femenino presentó una tasa de 2,65. El grupo etario con mayor TM es el de 80 y más con 141,7/100.000 habitantes. Para el IS por región, lideran las regiones XV y XII con 100%, siendo la más baja la XI con 83,3%. Discusión: El pico de TM para el año 2020 coincide con la pandemia por Covid-19, donde se reporta mayor mortalidad postoperatoria en pacientes infectados. El IS se mantiene mayor al 90% en el país, excepto en las Regiones X y XI, probablemente debido a la menor disponibilidad de centros de alta complejidad. Conclusión: Dada la ausencia de datos recientes de mortalidad para peritonitis, se realizó una actualización epidemiológica local, con perspectiva comparativa regional respecto a las TM de la población general y en mayores de 50 años.

Introduction: Peritonitis reaches an overall mortality of up to 60%. Given the lack of national epidemiological studies, it is proposed to calculate the mortality rate (MR) due to peritonitis between the years 2017-2021 in Chile. Methodology: Descriptive, ecological study about deaths by peritonitis between 2017 and 2021 in Chile (N=1,741), in a population older than 15 years old according to age group, sex, and region with data obtained from Departamento de Estadística e Información en Salud. Descriptive statistics were used, MR calculation, and Swaroop Index (SI). It did not require approval by an ethics committee. Results: A MR of 2.47/100,000 was calculated between the years 2017 and 2021, with 2020 being the highest with 3.07. The female sex presented a rate of 2.65. The age group with the highest MR is 80 and over with 141.7/100,000. For the SI by region, the XV and XII regions lead with 100%, the lowest being XI region with 83.3%. Discussion: The peak of MR for the year 2020 coincides with the Covid-19 pandemic and the highest postoperative mortality in infected patients. The SI remains above 90% in the country, except in X and XI regions, probably due to the lower availability of high complexity centers. Conclusion: Given the lack of recent mortality data for peritonitis, a local epidemiological update was carried out, with a regional comparative perspective regarding MR in the general population and in those over 50 years old.

Caracterización del tratamiento quirúrgico de los tumores hepáticos sólidos / Characterization of Surgical Management of Hepatic Tumors

Introducción: La historia de la cirugía del hígado abarca 28 siglos, lo que ha permitido su evolución desde considerar al hígado como un órgano intocable hasta realizar hepatectomías complejas y trasplante hepático. Esta investigación representa el balance de 10 años en la actividad de un grupo de cirugía hepatobiliar. Objetivo: Caracterizar el tratamiento quirúrgico de los tumores hepáticos sólidos en el Centro de Investigaciones Médico-Quirúrgicas entre los años 2009 y 2019. Métodos: Se realizó un estudio de tipo observacional, descriptivo, longitudinal y retrospectivo en el que se analizaron 129 pacientes que fueron tributarios de tratamiento quirúrgico. Resultados: Los tumores malignos representaron el 73 por ciento del total, dentro de este grupo se destacan los metastásicos con 50 casos. La morbilidad de esta cirugía fue del 13 por ciento y la mortalidad operatoria del 2 por ciento. La causa de muerte identificada fue el shock séptico por peritonitis generalizada. Conclusiones: Los tumores malignos fueron los más frecuentes. Se presentó una baja morbilidad encontrándose el derrame pleural como la complicación más usual. Existe una mortalidad acorde a los valores reportados para este tipo de cirugía(AU)

Introduction: The history of liver surgery covers twenty-eight centuries, which has allowed its evolution from considering the liver as an untouchable organ to performing complex hepatectomies and hepatic transplantation. This research describes the ten years' balance in the activity developed by a hepatobiliary surgery team. Objective: To characterize the surgical management of solid hepatic tumors in the Center for Medical-Surgical Research between 2009 and 2019. Methods: An observational, descriptive, longitudinal and retrospective study was carried out, for which 129 patients who underwent surgical treatment were analyzed. Results: Malignant tumors accounted for 73 percent of the total; within this group, metastatic tumors stand out, accounting for fifty cases. Morbidity of this surgery type was 13 percent, while operative mortality was 2 percent. The cause of death identified was septic shock due to generalized peritonitis. Conclusions: Malignant tumors were the most frequent. There was low morbidity, with pleural effusion as the most common complication. Mortality is consistent with the values reported for this type of surgery(AU)

Abdomen agudo quirúrgico en el paciente geriátrico / Surgical Acute Abdomen in the Geriatric Patient

RESUMEN Introducción: El abdomen agudo es causa frecuente de ingreso hospitalario en pacientes geriátricos. Objetivo: Caracterizar el comportamiento del abdomen agudo quirúrgico en el paciente geriátrico en un servicio de cirugía general. Métodos: Se realizó un estudio observacional descriptivo longitudinal de corte transversal en 169 pacientes. Los datos procedieron de las historias clínicas del Hospital Universitario "Manuel Ascunce Domenech" de Camagüey, desde enero de 2014 a diciembre de 2016 y se procesaron mediante estadística descriptiva, relacionándose algunas variables de manera no inferencial. Resultados: El 52,2 por ciento de los pacientes eran hombres. El 42,6 por ciento tenía edades entre 60 y 69 años. El 28,9 por ciento presentaron la oclusión intestinal como etiología. Hubo un 39,5 por ciento de complicaciones, el 54,5 por ciento de ellas fueron infecciosas. La mortalidad fue de un 22,5 por ciento. El 26,6 por ciento de los fallecidos presentaba oclusión intestinal. Conclusiones: Casi una décima parte de los pacientes fallecieron, la peritonitis fibropurulenta y el choque séptico fueron las causas más frecuentes de los decesos. La oclusión intestinal como causa de abdomen agudo pareció influir en la mortalidad de la muestra estudiada(AU)

ABSTRACT Introduction: Acute abdomen is a frequent cause of hospital admission in geriatric patients. Objective: To characterize the occurrence of acute surgical abdomen in the geriatric patient in a general surgery service. Methods: An observational, descriptive, longitudinal and cross-sectional study was carried out with 169 patients. The data were obtained from the medical records of Manuel Ascunce Domenech University Hospital in Camagüey, from January 2014 to December 2016, and were processed using descriptive statistics, relating some variables in a noninferential way. Results: 52.2 percent of the patients were men. 42.6 percent were aged between 60 and 69 years. 28.9 percent presented intestinal occlusion as an etiology. There were 39.5 percent of complications, 54.5 percent of which were infectious. Mortality was 22.5 percent. 26.6 percent of the deceased had intestinal obstruction. Conclusions: Almost one tenth of the patients died, with fibrinopurulent peritonitis and septic shock being the most frequent causes of death. Intestinal occlusion as a cause of acute abdomen appeared to influence mortality in the sample studied(AU)

Peritonitis por fusarium en paciente en diálisis peritoneal domiciliaria / Fusarium peritonitis in a patient on home peritoneal dialysis

Introducción: La peritonitis fúngica es una complicación infrecuente pero grave para un paciente en diálisis peritoneal domiciliaria. Objetivo: Describir un caso de peritonitis fúngica en un paciente en diálisis peritoneal continua ambulatoria (DPCA). Métodos: Se presenta un paciente masculino de 53 años de edad, con antecedentes de hipertensión arterial, 9 años en diálisis peritoneal continua ambulatoria, con una desnutrición proteico energética moderada. Durante su tratamiento presentó varios episodios de peritonitis bacterianas, infecciones del orificio de salida y una recolocación de catéter peritoneal con cuff extruido. Se trabajó con sus antecedentes, cuadro clínico, agente etiológico y tratamiento. El diagnóstico se estableció por la presencia de líquido peritoneal turbio, conteo celular con más de 100 leucocitos/ul y cultivo con la presencia del hongo filamentoso. Resultados: En diciembre de 2017 se le diagnostica una peritonitis por fusarium, sin leucocitosis ni anemia, sí presentaba una hipoalbuminemia, se cultiva además pared de la habitación donde el paciente se realizaba los intercambios y se encuentra hongo filamentoso. En principio se comienza tratamiento con vancomicina y ceftacidima, posteriormente se cambia la ceftazidima por amikacina y finalmente, al tener resultado de cultivo y se muestra el patógeno, se inicia tratamiento con itraconazol, lamentablemente el paciente fallece a los 20 días. Conclusiones: Con esta investigación se analizan aspectos clínicos y microbiológicos de la peritonitis por fusarium, los cuales son poco conocidos en diálisis peritoneal domiciliaria(AU)

Introduction: Fungal peritonitis is an infrequent but serious complication for a patient on home peritoneal dialysis. Objective: To describe a case of fungal peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). Methods: A 53-year-old male patient is reported, with a history of arterial hypertension, 9 years on continuous outpatient peritoneal dialysis, moderate protein-energy malnutrition. During his treatment, he had several episodes of bacterial peritonitis, exit-site infections, and repositioning of a peritoneal catheter with an extruded cuff. We worked with his antecedents, clinical status, etiological agent and treatment. The diagnosis was established by the presence of cloudy peritoneal fluid, cell count higher than 100 leukocytes / ul, and culture with the presence of the filamentous fungus. Results: In December 2017, he was diagnosed with fusarium peritonitis, with no leukocytosis or anemia, he did present hypoalbuminemia. A culture was performed on the wall of the room where the patient had his exchanges and filamentous fungus was found. Initially, treatment started with vancomycin and ceftazidime, followed by amikacin. Finally, after having a culture showed the pathogen, treatment with itraconazole started. Unfortunately the patient died 20 days later. Conclusions: This research analyzes clinical and microbiological aspects of fusarium peritonitis, which are poorly understood in home peritoneal dialysis(AU)

Mortalidad por peritonitis secundaria en una unidad de cuidados intensivos / Mortality from secondary peritonitis in an intensive care unit

RESUMEN Introducción: La peritonitis secundaria es el proceso inflamatorio en la cavidad peritoneal generado por perforación, inflamación o gangrena de una estructura intraabdominal o retroperitoneal Objetivo: determinar las características clínicas y epidemiológicas de los fallecidos por peritonitis secundaria en la unidad de cuidados intensivos del Hospital Provincial Docente Clínico Quirurgico Doctor León Cuervo Rubio desde enero del 2017 a diciembre del 2018. Métodos: se realizó una investigación observacional, descriptiva, transversal para determinar las características clínicas y epidemiológicas de los fallecidos por peritonitis secundaria en la unidad de cuidados intensivos del hospital provincial docente clínico quirúrgico Doctor León Cuervo Rubio desde enero del 2017 hasta diciembre del 2018, universo el total de pacientes quirúrgicos y la muestra los 34 fallecidos por peritonitis secundaria, la fuente utilizada las historias clínicas de cada paciente, los datos se agruparon según variables, las variables cualitativas, la distribución de frecuencias fue en absolutas(numero) y relativas (porcientos). Resultados: los fallecidos son del sexo femenino, de 60 a 79 años, con estadía de 16 a 23 dias, el germen aislado en los cultivos fue la Escherichia coli, el índice de Mannhein fue mayor de 29, la principal complicación quirúrgica el absceso residual y sistémica la respiratoria. Conclusiones: la mortalidad por peritonitis secundaria continúa siendo un problema de salud en las unidades de cuidados intensivos a pesar de contar con todos los medios para su tratamiento y el índice de Mannhein continúa siendo un buen predictor de mortalidad (AU).

SUMMARY Introduction: Secondary peritonitis is the inflammatory process in the peritoneal cavity generated by perforation, inflammation or gangrene of an intra-abdominal or retroperitoneal structure Objective: to determine the clinical and epidemiological characteristics of those killed by secondary peritonitis in the intensive care unit of the Doctor Leon Cuervo Rubio Surgical Clinical Teaching Provincial Hospital from January 2017 to December 2018. Methods: an observational, descriptive, cross-sectional investigation was carried out to determine the clinical and epidemiological characteristics of those killed by secondary peritonitis in the intensive care unit of the provincial surgical clinical teaching hospital Doctor León Cuervo Rubio from January 2017 to December 2018, universe the total of surgical patients and the sample of 34 deaths due to secondary peritonitis, the source used the medical records of each patient, the data were grouped according to variables, qualitative variables, frequency distribution was absolute (number) and relative (percent) ). Results: the deceased are of the female sex, from 60 to 79 years, with a stay of 16 to 23 days, the germ isolated in the cultures was Escherichia coli, the Mannhein index was greater than 29, the main surgical complication the residual abscess and systemic respiratory. Conclusions: Mortality from secondary peritonitis continues to be a health problem in intensive care units despite having all the means to treat it and the Mannhein index continues to be a good predictor of mortality (AU).

Morbilidad y mortalidad por peritonitis secundaria en el servicio de cirugía / Morbidity and Mortality due to Secondary Peritonitis in the Surgery Service

RESUMEN Introducción: La peritonitis secundaria se origina por contaminación de la cavidad peritoneal, continúa siendo una enfermedad grave con morbilidad y mortalidad altas. Objetivo: Determinar la morbilidad y la mortalidad por peritonitis secundaria en el Servicio de Cirugía del Hospital General Docente Comandante Pinares. Método: Se realizó un estudio descriptivo, prospectivo y observacional de pacientes que ingresaron en el servicio de Cirugía General con peritonitis secundaria, entre octubre de 2015 y marzo de 2018. De un universo de 40 pacientes se seleccionó una muestra de 36 enfermos que cumplieron con los criterios de inclusión. Se utilizaron métodos estadísticos descriptivos y cálculos con valores porcentuales. Resultados: La mayor incidencia corresponde al sexo masculino 19 (52,8 por ciento) predominando entre 50 y 69 años (38,9 por ciento); el hábito de fumar es la comorbilidad más frecuente para el 52,8 por ciento de los pacientes; las complicaciones más representadas fueron el síndrome perforativo que causó el 22,2 por ciento de las peritonitis, seguido por la oclusión intestinal (16,7 por ciento), el íleo paralítico (25 por ciento) y el desequilibro hidroelectrolítico y ácido-básico (19,4 por ciento); al 52,8 por ciento de los enfermos se les realizó laparotomía con lavado a gran escala de la cavidad abdominal, el resto recibió laparotomía programada (33,3 por ciento) y a demanda (13,9 por ciento); el 77,8 por ciento de los pacientes egresaron vivos, mientras que un 22,2 por ciento (8 pacientes) fallecieron. Conclusiones: La morbilidad y la mortalidad en los pacientes con peritonitis secundaria continúa siendo un problema de salud que requiere de diagnósticos e intervenciones oportunos(AU)

ABSTRACT Introduction: Secondary peritonitis is caused by contamination of the peritoneal cavity. It continues to be a serious disease with high morbidity and mortality. Objective: To determine morbidity and mortality due to secondary peritonitis in the Surgery Department of Comandante Pinares General Teaching Hospital. Method: A descriptive, prospective and observational study was carried out with patients admitted to the general surgery service with secondary peritonitis between October 2015 and March 2018. From a population of 40 patients, a sample of 36 patients who met the inclusion criteria was chosen. Descriptive statistical methods and calculations with percentage values were used. Results: The highest incidence corresponds to the male sex 19 (52.8 percent), with a predominance of the group between 50 and 69 years old (38.9 percent); smoking is the most frequent comorbidity, accounting for 52.8 percent of patients; the most represented complications were the perforation syndrome, which caused 22.2 percent of the peritonitis, followed by intestinal occlusion (16.7 percent), paralytic ileus (25 percent) and the electrolyte and acid-base imbalance (19.4 percent); 52.8 percent of patients underwent laparotomy with large-scale lavage of the abdominal cavity, the rest received scheduled laparotomy (33.3 percent) or on demand (13.9 percent); 77.8 percent of patients were discharged alive, while 22.2 percent (8 patients) died. Conclusions: Morbidity and mortality in patients with secondary peritonitis continues to be a health problem that requires timely diagnosis and intervention(AU)

Utilidad del índice de Mannheim en pacientes con peritonitis difusa. 2012 -2014 / Usefulness of the Mannheim index in patients with diffuse peritonitis. 2012 -2014

Evaluar la viabilidad y utilidad del uso del índice de Mannheim en pacientes con peritonitis difusa como predictor de mortalidad en el Servicio de Cirugía General del Hospital Dr. Luis Razetti de Barinas, Venezuela. Métodos: Estudio observacional, descriptivo y transversal, enmarcado en una investigación epidemiológica de campo no experimental, del 01 de enero 2012 hasta 30 junio 2014. Resultados: Se incluyeron 156 pacientes, 88 hombres (56,4 %) y 68 mujeres (43,6 %), con una edad promedio de 49,44 años. Índice de Mannheim promedio de 27,21 puntos. Mortalidad general de 22,4 % (35 fallecidos). Setenta y cuatro pacientes con puntaje menor de 26 y mortalidad específica de 1,35 %, 82 pacientes con puntaje mayor de 26 y mortalidad específica de 41,46 %. La falla orgánica estuvo en el 41,7% de los casos y en el 100 % de los fallecidos. Estancia hospitalaria promedio de 6,45 días. Sensibilidad del índice de Mannheim del 97,14 % y especificidad del 60,33 % como predictor de mortalidad. Conclusiones: el índice de peritonitis de Mannheim constituye una herramienta útil, reproducible y de fácil aplicación por el cirujano para el pronóstico de mortalidad en pacientes con peritonitis del Hospital Dr. Luis Razetti de Barinas, los pacientes con índice igual o mayor de 26 puntos presentan un peor pronóstico y mayor mortalidad, por lo que deben ir a sala de cuidados intermedios o críticos, aplicando y ajustando un adecuado manejo y tratamiento(AU)

To evaluate the feasibility and usefulness of the use of the Mannheimen index in patients with diffuse peritonitis as a predictor of mortality in the General Surgery Service of the Dr. Luis Razetti Hospital in Barinas, Venezuela. Method: Observational, descriptive and cross-sectional study, framed in a non-experimental field epidemiological investigation, from January 1, 2012 to June 30, 2014. Results: A total of 156 patients, 88 men (56.4 %) and 68 women (43.6 %), with an average age of 49.44 years. Average Mannheim index of 27.21 points. Overall mortality of 22.4 % (35 deaths). 74 patients with a score below 26 and specific mortality of 1.35 %, 82 patients with a score greater than 26 and a specific mortality of 41.46 %. Organic failure was in 41.7% of cases and 100 % of those killed. Hospital stay of 6.45 days on average. The study favors the Mannheim index as a predictor of mortality with a sensitivity of 97.14 %, and a specificity of 60.33 %. Conclusion: the Mannheim peritonitis index is a useful, reproducible and easily applied tool by the surgeon for the prognosis of mortality in patients with peritonitis, patients with an index equal to or greater than 26 points have a worse prognosis and higher mortality. what should go to the intermediate or critical care room, applying and adjusting proper management and treatment(AU)

Mortalidad por peritonitis secundaria en el Hospital General Docente Dr Agostinho Neto de Guantánamo. Factores determinantes / Mortality due to secondary peritonitis in the General Teaching Hospital Dr Agostinho Neto from Guantánamo. Determining factors

Introducción: en la unidad de cuidados intensivos no siempre se conocen los factores que determinan el pronóstico del paciente con peritonitis. Objetivo: precisar los factores determinantes de la mortalidad por peritonitis secundaria en esta unidad en el Hospital "Dr. Agostinho Neto" durante los años 2014­2016. Método: se realizó un estudio analítico prospectivo y longitudinal de todos los pacientes ingresados en la citada UCI por peritonitis secundaria en los años 2014­2016 (n=70), los que se agruparon según fueran egresados vivos o fallecidos. Se precisaron las variables más relacionadas con la probabilidad de que el paciente falleciera y las más frecuentes en los fallecidos. Se calculó el riesgo absoluto (RA) de cada variable. Resultados: los factores más frecuentes fueron: fiebre (n=53), Síndrome respuesta inflamatoria sistémica (n=51) y la leucocitosis/desviación izquierda (n=51). Los factores con mayor probabilidad de determinar la muerte fueron: fallo multiorgánico (RA 17.8), fluido peritoneal fecaloideo (RA 7.8) y choque séptico (RA 7.3). Conclusión: Los factores que determinan la mortalidad por peritonitis secundaria son: la peritonitis difusa, presencia de fallo multiorgánico, hipoxemia ≤ 85 mmHg y/o Sp02 ≤ 90 %, edad ≥ 60 años, presión intrabdominal poscirugía ≥ 21 cm H2O (15 mmHg), síntomas ≥ 24 h antes de cirugía, choque séptico, fluido peritoneal fecaloideo, origen colónico de la peritonitis(AU)

Introduction: the factors that determine the prognosis of the patient with peritonitis are not always known in the intensive care unit. Objective: to determine the determinants of mortality due to secondary peritonitis in this unit at the Hospital "Dr. Agostinho Neto" during the years 2014-2016. Method: a prospective, longitudinal, and analytical study was conducted of all the patients admitted to the ICU for secondary peritonitis in the years 2014-2016 (n=70), which were grouped according to graduates alive or deceased. The variables most related to the probability of the patient's death and the most frequent in the deceased were specified. The absolute risk (AR) of each variable was calculated. Results: the most frequent factors were: fever (n = 53), systemic inflammatory response syndrome (n = 51) and left leukocytosis/deviation (n = 51); the factors most likely to determine death were multiorgan failure (RA 17.8), fecaloid peritoneal fluid (RA7.8) and septic shock (RA 7.3). Conclusions: The factors that determine mortality due to secondary peritonitis: diffuse peritonitis, presence of multi-organ failure, hypoxemia ≤ 85 mmHg or Sp02 ≤ 90 %, age ≥ 60 years, intra-abdominal pressure after surgery ≥ 21 cm H2O (15 mmHg), symptoms ≥ 24 h before surgery, septic shock, fecaloid peritoneal fluid, colonic origin of peritonitis(AU)

Factores pronósticos de mortalidad por peritonitis secundaria en pacientes ingresados en una unidad de cuidados intensivos / Mortality prognosis factors due to secondary peritonitis in patients admitted in an intensive care unit

Se realizó un estudio observacional y analítico, de casos y controles, de 77 pacientes con peritonitis agudas secundarias, ingresados en la Unidad de Cuidados Intensivos del Hospital Clinicoquirúrgico Universitario "Dr. Ambrosio Grillo Portuondo" de Santiago de Cuba, en el período de enero del 2014 a igual mes del 2016, para identificar los factores pronósticos de mortalidad en ellos. Entre los principales resultados se obtuvo un predominio de las perforaciones como causa de muerte y del sexo femenino entre los fallecidos. Se encontró una elevada especificidad para el índice de Mannheim y no existió asociación entre la edad, la necesidad de repetir la laparotomía, la presencia de sepsis y las enfermedades metabólicas y las inmunosupresoras con la probabilidad de morir. Los factores pronósticos con significación estadística relacionados con la probabilidad de morir por una peritonitis secundaria, fueron el estado físico, el tiempo preoperatorio y la disfunción múltiple de órganos.

An observational and analytic cases and controls study of 77 patients with acute secondary peritonitis, admitted in the Intensive Care Unit of "Dr. Ambrosio Grillo Portuondo" University Clinical Surgical Hospital in Santiago de Cuba was carried out, in the period of January, 2014 to same month of 2016, to identify the prognosis factors of mortality in them. A prevalence of perforations as cause of death and prevalence of the female sex in the dead patients were obtained among the main results. A high specificity for the Mannheim index was found and association didn't exist between the age, the necessity to repeat laparotomy, the sepsis presence and the metabolic and immunosuppressive diseases with the probability of dying. The prognosis factors with statistical significance related to the probability of dying due to a secondary peritonitis were the physical status, the preoperative time and the multiple organs dysfunction.

EFFECTS OF TOPICAL TREATMENT WITH EUPHORBIA TIRUCALLI LATEX ON THE SURVIVAL AND INTESTINAL ADHESIONS IN RATS WITH EXPERIMENTAL PERITONITIS / EFEITOS DO TRATAMENTO TÓPICO COM O LÁTEX DA EUPHORBIA TIRUCALLI NA SOBREVIDA E NAS ADERÊNCIAS INTESTINAIS DE RATOS COM PERITONITE EXPERIMENTAL

Background: The use of plants of the family Euphorbiaceae, particularly Euphorbia tirucalli (avelós) has been popularly widespread for treating a variety of diseases of infectious, tumoral, and inflammatory. Aim: To demonstrated antimicrobial and immunomodulatory effects of these extracts, evaluating the effect of a topical treatment with an aqueous solution of avelós latex on the survival and on intestinal adhesions in rats with experimental peritonitis. Methods: Peritonitis was induced in 24 Wistar rats, that were randomized into four groups of six as follows: (1) Control group (n=6), no treatment; (2) Antibiotic group (n=6), treatment with a single intramuscular dose of antibiotic Unasyn; (3) Saline group (n=6), the abdominal cavity was washed with 0.9% saline; and (4) E.tirucalli group (n=6), the abdominal cavity was washed with E. tirucalli at a concentration of 12 mg/ml. The animals that died were necropsied, and the time of death was recorded. The survivors were killed on postoperative day 11, and necropsy was subsequently performed for evaluation of the intestinal adhesions. Results: Significant differences were observed in the control and antibiotic groups (p<0.01) with respect to the survival hours when compared with the saline and E. tirucalli groups. There was no significant difference (p>0.05) in the survival of animals in the saline andE. tirucalli groups; however, one animal died in the saline group. Necropsy of the animals in the saline and E. tirucalligroups showed strong adhesions resistant to manipulation, between the intestinal loops and abdominal wall. The remaining groups did not show any adhesions. Conclusions: Topical treatment with E. tirucalli latex stimulated an increased formation of intestinal adhesions and prevented the death of all animals with peritonitis.

Racional: O uso de plantas da família Euphorbiaceae, principalmente a Euphorbia tirucalli (avelós), tem sido popularmente difundido para o tratamento de uma variedade de doenças de natureza infecciosa, tumoral e inflamatória. Objetivo: Avaliar o efeito do tratamento tópico com a solução aquosa do látex do avelós na sobrevida e nas aderências intestinas de ratos com peritonite experimental. Métodos: Foi induzido peritonite em 24 ratos Wistar e randomizados em quatro grupos de seis, assim distribuídos: 1) Controle - (n=6), nenhum tratamento; 2) Antibiótico - (n=6), tratamento com dose única intramuscular de antibiótico Unasyn (Pfizer - São Paulo); 3) Salina - (n=6), lavagem da cavidade abdominal com solução fisiológica 0,9%; 4) E.Tirucalli - (n=6), lavagem da cavidade abdominal com E. tirucalli na concentração de 12 mg/ml. Os animais que morreram foram submetidos à necropsia e o horário do óbito anotado. Os sobreviventes foram submetidos à eutanásia no 11odia de pós-operatório e, posteriormente, realizou-se a necropsia para avaliação da formação de aderências. Resultados: Os grupos controle e antibiótico obtiveram diferença significativa (p<0,01) com relação às horas de vida entre os grupos salina e E. tirucalli. Não houve diferença significativa (p>0,05) na sobrevida dos animais dos grupos salina e E. tirucalli, no entanto, houve um óbito no grupo salina. A necropsia dos animais dos grupos salina e E. tirucalli mostrou aderências firmes e resistentes à manipulação entre alças intestinais e parede abdominal. Os demais grupos não tiveram formação de aderências. Conclusão: O tratamento tópico com o látex da E. tirucalli estimulou maior formação de aderências intestinais e evitou o óbito de todos animais com peritonite até o período avaliado.

Severe autogenously fecal peritonitis in ageing Wistar rats. Response to intravenous meropenem

PURPOSE: To evaluate the treatment outcome of severe peritonitis in rats with increasing age. METHODS: Thirty Wistar rats stratified in three groups: group I - six month-old; group II - 12 month-old; and group III - 18 month-old, underwent autogenously fecal peritonitis (6 ml/kg rat), and were treated with intravenous meropenem. The survival animals were followed-up for 45 days. The variables were expressed by their mean and standard error of the mean (SEM). p<0.05 was used for rejecting the null hypothesis. The study was approved by the Ethics Committee. RESULTS: There was a significant increase in the mortality and morbidity in elderly rats. Of interest, even among young survival rats presenting with severe residual abscesses both in the abdomen and thorax cavities, they present an almost normal life. CONCLUSIONS: The treatment of severe autogenously fecal peritonitis with intravenous meropenem reached reasonable results in rats with six and twelve months of age, even considering residual abscesses on abdomen and thorax cavities. However, the great majority (80%) of elderly rats could not overcome the initial severe infectious challenge, proving that ageing is a very important risk factor for impairing immune response. Thus, sepsis remains a challenging situation, especially in elderly. .

Peritonitis aguda secundaria. Causas, tratamiento, pronóstico y mortalidad / Acute generalize peritonitis. Causes, treatment, prognosis and mortality

Antecedentes: La peritonitis aguda secundaria (PAS) es una emergencia común y su tratamiento fundamental es la intervención quirúrgica. Sin embargo a pesar de los avances en las técnicas quirúrgicas; la antibiótico-terapia y el soporte de los cuidados intensivos conlleva una alta morbilidad y mortalidad, siendo su manejo difícil y complejo. PACIENTES Y MÉTODO: 99 casos de PAS sometidos a laparotomía en el período 2006-2010 (56 varones y 43 mujeres) son analizados de manera retrospectiva en un estudio descriptivo que tiene como objetivo identificar las causas más frecuentes, establecer el porcentaje de certeza diagnóstica preoperatoria, investigar las complicaciones postoperatorias, evaluar factores pronósticos de mortalidad según el índice de Mannheim y determinar la mortalidad. RESULTADOS: La principal causa de peritonitis secundaria fue la apendicular (19%), seguida de peritonitis postoperatoria (17%), en tercer lugar, la perforación de úlcera gastroduodenal, y de asas delgadas (16% cada una), luego, la peritonitis de origen ginecológico (12%), seguidas por las de origen colónico (10%). El tratamiento más frecuente fue el control del foco de contaminación, lavado y secado, con cierre de la cavidad peritoneal (93%). El abdomen abierto, contenido con bolsa de Bogotá se utilizó en 7% de los casos. La mortalidad asociada con la peritonitis secundaria fue de 16%. CONCLUSIONES: Las causas más frecuentes de peritonitis secundaria, fueron, la apendicular, seguidas de las peritonitis postoperatorias. El porcentaje de certeza diagnóstica preoperatoria encontrado en esta serie fue del 27%. Las complicaciones más frecuentes del foco operatorio fueron las dehiscencias de suturas, seguidas de las colecciones a nivel del lecho operatorio

Background: Acute secondary peritonitis (ASP) is a common emergency, its fundamental treatment is surgical intervention, whoever despite the advances on surgical techniques, antibiotic-therapy and intensive care support; mortality and morbidity stay high, while its management remain difficult and complex. PATIENTS AND METHOD: 99 patients with ASP, that underwent laparotomy at the First Department of Surgical Clinics, during the 2006-2010 period (56 males and 43 females) were retrospectively studied with the purpose of identify the main causes, establish the accuracy of preoperative diagnosis, investigate postoperative complications, evaluate prognosis factors of mortality according to the Mannheim index and determinate the mortality. RESULTS: Perforated appendix, was the cause in 19%, follow by postoperative peritonitis (17%), in third place, perforation of the stomach and duodenum and small intestine (16%, each), follow by female internal genital organs (12%) and perforation of the colon (10%). The main treatment was controlling the local point of contamination, with primary close of the peritoneal cavity (93%), Open abdomen contain by Bogotá bag was used in 7% of the cases. The associated mortality was 16%. CONCLUSIONS: Main causes of secondary peritonitis were the appendix, follow by postoperative peritonitis. The preoperative diagnosis accuracy was 27%. The main complications found were suture failure, follow by intra-abdominal collections.

Influence of the peritoneal lavage with bupivacaine on the survival and resistance of colonic anastomoses performed under fecal peritonitis in rats

PURPOSE: To evaluate the effects of peritoneal lavage with bupivacaine on survival and initial resistance of anastomosis on distal colon, performed under peritonitis or not. METHODS: Forty rats, weighing from 300 to 350g (321.29±11.31g), were randomly divided in four groups and underwent laparotomy and anastomosis on the distal colon six hours after induction of peritonitis by intraperitoneal injection of autologous fecal material or not. Group 1: No peritonitis and lavage with 3ml NS; Group 2: No peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS; Group 3: Peritonitis and lavage with 3ml NS; Group 4: Peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS. Necropsies were performed on the animals that died and the time of death was recorded. Surviving animals were submitted to euthanasia on the fifth post-operative day and Total Energy of Rupture biomechanical test (TER) was applied. RESULTS: Group 4 showed survival increase compared to Group 3, without statistical significance. Group 3 presented the smallest average TER, with statistical significance. CONCLUSION: Peritonitis increased mortality and influenced negatively the resistance of colic anastomosis in rats. Peritoneal lavage with bupivacaine increased anastomotic resistance.

Procedimiento de Hartmann vs resección y anastomosis primaria en peritonitis diverticular de colon izquierdo por cirugía abierta: revisión sistemática de la literatura / Hartmann’s procedure and resection with primary anastomosis in diverticular peritonitis

Introduction: colonic diverticulosis, as diverticulitis, is a frequent disease in different stages of evolution. There is uncertainty about treatment options that are used in secondary peritonitis. The aim of this study is to determine the best treatment option for patients with peritonitis secondary to diverticulitis of the left colon in terms of postoperative morbidity (POM) and mortality, comparing Hartmann's procedure (HP) and resection with primary anastomosis (RPA). Material and Methods: systematic review. Studies in adults with peritonitis secondary to diverticulitis of the left colon treated with HP and RPA published between 1990 and 2011 were analyzed. TRIPDATABSE, IWO, MEDLINE, SciELO and LILACS databases were consulted and search strategies were applied using MeSH and free terms. Selected studies were analyzed using a score of methodological quality (MQ). The following variables were considered: mortality, POM, hospital stay, percentage of bowel transit reconstitution in patients undergoing HP and MQ of primary studies. Results: 26 primary studies were analyzed (47 series). There were no significant differences in the variable mortality (p = 0.0805), but significant difference was observed in POM (incompletely reported) (p = 0.0187). The median of MQ of the studies was 11 points for HP series and 10 for RPA series. Conclusion: the available evidence to determine the best treatment option in terms of mortality and POM in this kind of patients is insufficient. Studies with better level evidence and MQ are needed to clarify the uncertain.

Introducción: la enfermedad diverticular del colon es una entidad frecuente, como también la diverticulitis en sus diferentes estadios de evolución. Existe incertidumbre respecto de las opciones terapéuticas que se utilizan en el tratamiento de la peritonitis diverticular de colon izquierdo (PDCI). El objetivo de este estudio es determinar la mejor opción de tratamiento para pacientes con PDCI entre procedimiento de Hart-mann (PH) y resección con anastomosis primaria (RAP), en términos de mortalidad y morbilidad postoperatoria (MPO). Material y Método: revisión sistemática de la literatura. Se analizaron estudios realizados en adultos con PDCI tratados con PH y RAP, publicados entre 1990 y 2011. Se consultó en las bases de datos TRIPDATABSE, IWO, MEDLINE, SciELO y LILACS, utilizando estrategias de búsqueda con términos MeSH, palabras libres y operadores booleanos. Los estudios seleccionados fueron analizados mediante un escore de calidad metodológica (CM). Se consideraron las variables mortalidad, MPO, estadía hospitalaria, porcentaje de reconstitución de tránsito en pacientes sometidos a PH y CM de los estudios primarios. Resultados: se analizaron 26 estudios primarios (47 series de pacientes). No se encontraron diferencias significativas respecto de la variable mortalidad (p = 0,0805); pero sí en la variable MPO, reportada de forma incompleta (p = 0,0187). La mediana de la CM de los estudios primarios fue de 11 puntos para las series de PH y de 10 para las de RAP. Conclusión: la evidencia disponible no permite determinar la mejor alternativa terapéutica en términos de mortalidad y MPO en este tipo de pacientes. Se requieren estudios de mejor nivel de evidencia y CM para aclarar esta incertidumbre.

Autogenous fecal peritonitis in Wistar rats with permanent bilateral carotid occlusion: morbidity, mortality and microbiological response

PURPOSE: To investigate morbidity, mortality and microbiological response to fecal peritonitis induced in Wistar rats with permanent bilateral carotid ligation (PBCL). METHODS: Fecal peritonitis was induced in 30 rats, with 10 animals in each group: Group1 - normal young animals; Group2 - normal mature animals; and Group3 - rats with PBCL after four months postoperative follow-up. Peritonitis was induced with 10% stool suspension. Morbidity and mortality were evaluated. The survival animals after seven days were euthanized for tests. For microbiological studies blood were collected from the carotids and right ventricle; and fragments of lung and peritoneum. RESULTS: The morbidity and mortality of young animals were significantly lower than in mature animals with and without PBCL. There was no difference in morbidity and mortality among mature rats with and without PBCL. The diversity of microorganisms producing septicemia was similar to native micro biota of the large bowel. CONCLUSIONS: The immune response was more efficient in young animals, represented by significant less morbidity and no natural mortality. PBLC did not affect morbidity and mortality in mature rats. The immune response to fecal peritonitis has age as an independent predictor.

Evaluation of peritoneal reinfection after fecal peritonitis / Avaliação da reinfecção peritoneal após peritonite fecal

PURPOSE: To investigate the role of a previous abdominal infection on peritonitis. METHODS: Twenty-seven adult female Wistar rats were submitted to fecal peritonitis by an intraperitoneal injection of a solution of rat feces. The animals were divided into three groups (n = 9 each): Group 1 - control - intraperitoneal injection of an amount of fecal solution known to be lethal (10 ml/kg), Group 2 - reinfection - intraperitoneal injection of an amount of fecal solution known not to be lethal (2 ml/kg) followed by an injection of fecal solution (10 ml/kg) 30 days later, Group 3 - late reinfection - intraperitoneal injection of 2 ml/kg feces followed by an injection of 10 ml/kg four months later. RESULTS: All animals in Group 1 died within seven days after injection of the fecal solution. In contrast, in the pre-infected Group 2 only one animal died 24 hours after injection of the fecal solution (10 ml/kg). In Group 3, eight of the nine animals in each subgroup died over a period of seven days. The difference in survival time between groups 1, 2 and 3 was for p = 0.0042 (logrank test). CONCLUSIONS: Milder peritoneal sepsis due to fecal infection raises the organic resistance to a new more intense fecal contamination occuring after a short period of time. However, this protection did not persist over a prolonged period of time.

OBJETIVO: Investigar o efeito de uma nova infecção peritoneal após realização de peritonite fecal prévia. MÉTODOS: Foram utilizados 27 ratos fêmea Wistar adultos submetidos à peritonite fecal com injeção intraperitoneal de uma solução de fezes de ratos. Os animais foram distribuidos em três grupos (n = 9): Grupo 1 - controle: injeção intraperitoneal de solução de fezes com uma quantidade sabidamente letal (10 ml/kg); Grupo 2 - reinfecção: injeção intraperitoneal de solução de fezes com uma quantidade sabidamente não letal (2 ml/kg) e, após 30 dias, injeção de solução de fezes (10 ml/kg); Grupo 3 - reinfecção tardia: injeção intraperitoneal de fezes a 2ml/kg e, após quatro meses, injeção de 10ml/kg. RESULTADOS: Todos os animais do Grupo 1 morreram dentro de sete dias após a injeção da solução de fezes. Em contraste, no grupo de reinfecção precoce Grupo 2 apenas um animal morreu 24 horas após a injecção da solução de fezes (10 ml / kg). No Grupo 3, oito dos nove animais morreram durante um período de sete dias. A diferença no tempo de sobrevivência entre os grupos 1, 2 e 3 foi de p = 0,0042 (teste de logrank). CONCLUSÕES: Uma sepse peritoneal menor por fezes eleva a resistência orgânica a nova contaminação fecal mais intensa que ocorra após um período curto. Contudo, essa defesa não persiste por tempo mais prolongado.

Valor predictivo de mortalidad del indice de peritonitis de Mannheim / Predictive mortality value of the peritonitis index of Mannheim

OBJETIVO: Determinar el valor predictivo del índice de peritonitis de Mannheim en pacientes con peritonitis en el Hospital Nacional Cayetano Heredia. MATERIAL Y METODOS: Es un estudio prospectivo, de 103 pacientes, mayores de 14 años, con diagnóstico de peritonitis, entre Noviembre 2004 - Abril 2005. Para su análisis se utilizo la prueba de chi cuadrado con coeficiente de Pearson, y la prueba de T de student. Para el análisis de los datos se utilizaron dos modalidades, primero los pacientes fueron divididos en 3 grupos, según el valor del índice de Mannheim, <21, de 21 a 29, y >29, y en 2 grupos, ≤26 y >26 puntos. Se realizó el estimado de sobrevida de Kaplan Meier, utilizando el programa estadístico STATA 8.0 RESULTADOS: se obtuvo una mortalidad del 50% en pacientes con índice mayor de 26 puntos. Se encontró una sensibilidad 95,9%, una especificidad del 80%, con un valor predictivo positivo 98,9% y un valor predictivo negativo del 50%. Al considerar 3 grupos, <21, 21-29 y >29 puntos, se encontró una mortalidad del 60% en pacientes con índice mayor de 29. Se realizó una curva de sobrevida obteniéndose una diferencia significativa con un p=0,0098.CONCLUSIONES: La clasificación en 3 grupos presenta diferencia estadísticamente significativa, por lo que se recomienda su uso para la evaluación e inicio de medidas agresivas.

OBJECTIVE: To determine the predictive value of the index of peritonitis of Mannheim in patients with peritonitis in the Hospital Nacional Cayetano Heredia.PATIENTS AND METHODS: A prospective study appears, of 103 patients, greater of 14 years, with I diagnose of peritonitis, between November 2004 to April 2005. For its analysis I am used the square test of chi with coefficient of Pearson, and the test of T of student. For the analysis of the data two modalities were used, the first patients were divided in 3 groups, according to the value of the index of Mannheim, < 21, of 21 to 29, and > 29, and in 2 groups, ≤ 26 and > 26 points. I am made considered of survival of Kaplan the Meier, using statistical program STATA 8.0. RESULTS: a mortality of 50% in patients with greater index of 26 points was obtained. One was a sensitivity 95.9%, a specificity of 80%, with positive a predictive value 98.9% and a negative predictive value of 50%. When considering 3 groups, < 21, 21-29 and > 29 points, was a mortality of 60% in patients with greater index of 29. I am made a survival curve obtaining itself a significant difference with a p=0, 0098. Figure 2. CONCLUSIONS: We found that the classification in 3 groups presents statistically significant difference, reason why recommended its use for the evaluation and beginning of aggressive measures.

Sepsis intraabdominal diseminada: análisis de 119 operados en 10 años / Spreading intra-abdominal sepsis: analysis of 110 patients operated on during 10 years

INTRODUCCIÓN. La atención a los pacientes con de sepsis intraabdominal diseminada continúa presentado variantes de conducta. A pesar de los adelantos terapéuticos, los índices de mortalidad continúan siendo elevados y oscilan entre el 30 y el 60 por ciento. Dicha oscilación está influenciada, en ocasiones, por la selección de la muestra. El objetivo principal del presente estudio fue conocer el comportamiento de la sepsis intraabdominal diseminada entre los años l995 y 2005, en nuestra institución. MÉTODOS. Se realizó un estudio retrospectivo y prospectivo de los pacientes con sepsis intraabdominal diseminada, operados entre l995 y 2005 en el Servicio de Cirugía General del Hospital Docente Clinicoquirúrgico Joaquín Albarrán. Fueron revisados 119 expedientes clínicos y 49 protocolos de necropsia. Se estudiaron grupos etarios, patologías más frecuentes, síntomas y signos, efectividad en el diagnóstico, métodos de tratamientos, complicaciones, gérmenes causales y mortalidad. RESULTADOS. Hubo 49 fallecidos (41,1 por ciento) y se constató un incremento del 3 por ciento de la mortalidad en comparación con el año anterior, debido fundamentalmente al aumento del número de dehiscencias de suturas intestinales, ocurridas en el 22,5 por ciento de los fallecidos por falta de una decisión quirúrgica precoz. La mayoría de estos pacientes tenían enfermedades oncoproliferativas. El método de tratamiento local más empleado fue el cerrado (72 pacientes; 60,5 por ciento). En general hubo un cumplimento adecuado del algoritmo de trabajo utilizado en el Servicio(AU)

INTRODUCTION: Care of patients presenting with spreading intra-abdominal sepsis continues presenting behavior variations. Despite therapeutical advances, mortality rates are still high, and fluctuate between 30 percent and 60 percent. Sometimes, such fluctuation is influenced by sample selection. The main objective of present paper was to know the behavior of spreading intra-abdominal sepsis between 1995 and 2005 in our institution. METHODS: Authors made a retrospective and prospective study of patients presenting with spreading intra-abdominal sepsis, operated on between 1995 and 2005 in General Surgery Service of Joaquín Abarrán Clinical Surgical Teaching Hospital. A total of 119 clinical records and 49 necropsy protocols were reviewed. Age groups, more frequent pathologies, symptoms and sings, diagnosis effectiveness, treatment methods, complications, causal germs, and mortality were studied. RESULTS: There were 49 deceased (41, 1 percent) and a mortality increment of 3 percent was confirmed, compared with past year, basically due to raise in number of intestinal suture dehiscences, occurred in 22,5 percent of deceased by a lack of early surgical decision. Most of these patients presented with onco-proliferative diseases. The more used local treatment was the closed one (72 patients; 60, 5 percent). In general, there was an appropriate fulfillment of work algorithm used in the service(AU)

Effects of peritoneal lavage with lidocaine on survival of rats with fecal peritonitis

PURPOSE: To study the effects of peritoneal lavage with a 2 percent lidocaine solution, on the survival of the rats submitted to peritonitis caused by their own feces. METHODS: Forty-eight Wistar rats, weighting between 300g and 330g (mean, 311,45 ±9,67g), were submitted to laparotomy 6 hours following induction of fecal peritonitis. Animals were randomly divided into four groups of 12 each as follows: 1- Control, no therapy; 2- Drying of the abdominal cavity; 3- Peritoneal lavage with saline and drying; 4- Peritoneal lavage with a 2 percent lidocaine solution and drying. Animals that died were submitted to necropsy and the time of their death recorded; survivors were killed on the post-operation 11th day and necropsied. RESULTS: Death occurred within 52 h in all animals of group 1; within 126 h in 100 percent of those of group 2; within 50 h in 50 percent of those of group 3. All animals of group 4 survived. Survival on the 11 th day was higher in groups 3 and 4 than in groups 1 and 2 (p<0.001), and higher in group 4 than in group 3 (p<0.01). CONCLUSION: Peritoneal lavage with a 2 percent lidocaine saline solution without adrenaline, prevented the mortality of all animals with fecal peritonitis .

OBJETIVO: Estudar o efeito da lavagem peritoneal com solução de lidocaína a 2 por cento na sobrevida de ratos com peritonite fecal por fezes autógenas. MÉTODOS: Foram utilizados 48 ratos Wistar, pesando entre 300g e 330g (M.A 311,45 ±9,67) submetidos à laparotomia 6 horas após a indução de peritonite, distribuídos aleatoriamente em 4 grupos: 1- (n=12) Controle, nenhum tratamento; 2- (n=12) Enxugamento da cavidade abdominal; 3- (n=12) Lavagem da cavidade abdominal com 3 ml de solução salina 0,9 por cento e enxugamento ; 4- (n=12) Lavagem da cavidade abdominal com 30 mg/Kg( ± 0,5 mL) de lidocaína 2 por cento ,sem adrenalina, e 2,5ml de solução salina 0,9 por cento e enxugamento. Os animais que faleceram foram necropsiados e o horário do óbito anotado. Os sobreviventes foram mortos no 11º dia de pós-operatório e realizou-se a necropsia. RESULTADOS: Houve 100 por cento de mortalidade nos animais do grupo 1, em 52 horas; 100 por cento nos animais do grupo 2, em 126 horas e 50 por cento nos animais do grupo 3 em 50 horas. Os animais do grupo 4 sobreviveram. A sobrevida, no 11º dia de pós-operatório, foi maior nos grupos 3 e 4 em relação aos grupos 1 e 2 ( p< 0,001) e maior nos grupos 4 que no grupo 3(p<0,01). CONCLUSÃO: A lavagem peritoneal com lidocaína a 2 por cento sem adrenalina e diluida em 2,5 ml de solução salina, foi eficaz para evitar o óbito, por 11 dias(eutanásia) em 100 por cento dos animais com peritonite fecal.