Radical Surgical Debridement in the Treatment of Advanced Generalized Bacterial Peritonitis

Abstract

The continued high mortality in patients with generalized peritonitis, treated by conventional means, led me, in 1963, to a study of the effects of radical surgical debridement in those patients in whom the source of contamination could be eliminated. Ninety-two patients have been treated with the described regimen. They varied from 3 to 69 years of age, and a variety of contamination sources were encountered. All were critically ill and over 90% had mechanical intestinal obstruction. Although these operations were tedious and often prolonged (average operating time, three hours), all patients survived and postoperative complications were surprisingly minimal. It is believed that the success of this method results from stopping further contamination and restoring the peritoneum to a state that allows normal host defense mechanisms to clear any residual infection.