When patients with appendicitis were excluded, there was no difference in mortality or complications between patients with CIAIs and NIAIs. Source control represents a key component of success in therapy of sepsis. It includes Opaganib in vivo drainage of infected fluids, debridement of infected soft tissues, removal of infected devices or foreign bodies, and finally, definite measures
to correct anatomic derangement resulting in ongoing microbial contamination and to restore optimal function. Recommendations have low grade due to the difficulty to perform appropriate randomized clinical trials in this respect. Percutaneous abscess drainage should be the primary procedure to treat postoperative localized intra-abdominal abscess without signs of generalized peritonitis (Recommendation 2 C). Some retrospective studies in the surgery and radiology
literature have documented the effectiveness of percutaneous drainage to treat postoperative localized intra-abdominal abscess [257–259]. Source control should be obtained as early as possible after the diagnosis of postoperative intra-abdominal peritonitis has been confirmed. Inability to control the septic source is associated significantly with increase in mortality (Recommendation 1 C). Inability to control the septic source is associated significantly with increase in mortality. Delaying relaparotomy for more than 24 h or the presence of organ failure result in higher check mortality in postoperative intra-abdominal infections. The value of physical tests and laboratory parameters in diagnosing
abdominal sepsis is limited. CT-scanning revealed the highest diagnostic accuracy. 5-Fluoracil Early relaparotomy appears to be the most reasonable option to treat postoperative peritonitis . Re-laparotomy strategy Some patients are prone to persisting intra-abdominal infection regardless of eradication of the source of infection and timely relaparotomy provides the only surgical option that significantly improves outcome. In these cases single operation may not be sufficient to achieve source control, thus re-exploration is necessary [261–263]. The decision to and when to perform a relaparotomy in secondary peritonitis is largely subjective and based on professional experience. Factors indicative of progressive or persistent organ failure during early postoperative follow-up are the best indicators for ongoing infection and associated positive findings at relaparotomy [264–266]. Three methods of local mechanical management of abdominal sepsis following initial laparotomy for source control are currently debated: (1) Open-abdomen (2) planned relaparotomy (3) on-demand relaparotomy On demand relaparotomy may be considered the preferred surgical strategy in patients with severe peritonitis because it has a substantial reduction in relaparotomies, health care utilization, and medical costs. (Recommendation 1 A) In 2007 van Ruler and coll.