Features of post-perforating bacterial peritonitis

Abstract

FEATURES OF POST-PERFORATING BACTERIAL PERITONITIS Kolosovych Ihor Doctor of Sci (Med), Professor, Head of the Department of Surgery №2 Bogomolets National Medical University, c. Kyiv, Ukrainе Currently, perforation of the duodenal ulcer remains one of the few сomplications of peptic ulcer disease, requiring an emergency emergency surgical intervention for life-threatening indications [1,2]. Traditionally it is considered that in 6-12 hours from the moment of perforation is possible performing organ-saving operative interventions, since peritonitis during this period has an aseptic character [3]. However, a fairly high frequency of early postoperative complications after intervention activities performed during this period indicates the need for a more detailed study of features and conditions of peritonitis during perforated duodenal ulcer [4]. The aim Study of the features and conditions of the bacterial process in the abdominal cavity with a perforated duodenal ulcer. Materials and methods. For the period from 2014 to 2020 the clinic operated on 200 patients with perforated duodenal ulcer. Men made up 80%, women – 20%. The age of the patients ranged from 16 to 98 years, the average age was 34.2±1.4 years. 36 patients (18%) were admitted to the hospital up to 6 hours from onset of the disease, 32 patients (16%) - after 6-12 hours, 98 patients (49%) - after 12-24 hours, and 34 patients (17%) - after more than 24 hours. 24 patients (12%) during the survey in general denied any stomach complaints until the perforation of the ulcer ("silent ulcer"). In 43 patients (21.5%), serous was found peritonitis, in 89 (44.5%) patients – serous fibrinous peritonitis and in 68 patients (34%) – purulent-fibrinous peritonitis. During the operation, the acidity of the peritoneal exudate was defined and performed bacteriological research using both standard media and media with different pH values. Results of the research. Of the 26 patients who were operated on within 6 months days from the time of perforation, in 17 patients (65.38%) cultures were sterile. In 9 patients (34.62%) microflora was represented by gram-positive them with cocci (Staphylococcus epidermidis, Staphylococcus saprophyticus, Streptococcus viridans), gram-negative rods (Klebsiela pneumoniae, Proteus mirabilis, Morganella morganii, Esherichia coli) and Candida fungi. Microflora was represented both in monoculture (77.78%) and in associations (22.22%). Among the patients who were operated on at term from 6 to 12 hours from the moment of perforation, the growth of microflora was not detected in 6 (31.58%) patients, and in 13 (68.42%) patients, the composition of microflora had no significant differences from the first group. In monoculture, the microflora was present in 7 (58.33%) patients, in associations – in 5 (41.67%). Peritoneal contents with perforated duodenal ulcer even in the first 6 hours from the moment of perforation in 34.62% is sterile, and in terms from 6 to 12 hours the quantity of positive results of bacteriological research of an exudate increases to 68.42%. Acidity of a peritoneal exudate is in the limits from 7.0 to 7.7 irrespectively of the time of its perforation. Analysis of the obtained results showed that the largest number of positive of sowing results (100%) was obtained at a medium pH value of 7.0. Conclusion. Therefore, optimal conditions for development are reproduced at a pH value of 7.0 flora that is sown from the exudate in case of a perforated duodenal ulcer. References 1. Francavilla ML, Pollock AN. Perforated Duodenal Ulcer. Pediatr Emerg Care. 2017 Mar;33(3):219-220. doi: 10.1097/PEC.0000000000001060. PMID: 28248764. 2. Clinch D, Damaskos D, Di Marzo F, Di Saverio S. Duodenal ulcer perforation: A systematic literature review and narrative description of surgical techniques used to treat large duodenal defects. J Trauma Acute Care Surg. 2021 Oct 1;91(4):748-758. doi: 10.1097/TA.0000000000003357. PMID: 34254960. 3. Pörner D, Von Vietinghoff S, Nattermann J, Strassburg CP, Lutz P. Advances in the pharmacological management of bacterial peritonitis. Expert Opin Pharmacother. 2021 Aug;22(12):1567-1578. doi: 0.1080/14656566.2021.1915288. Epub 2021 Apr 21. PMID: 33878993. 4. Kolosovych IV, Hanol IV, Cherepenko IV, Lebedieva KO, Korolova KO. Intrabdominal Pressure And Its Correction In Acute Surgical Pathology. Wiad Lek. 2022;75(2):372-376. PMID: 35307661.