CLOSED VERSUS OPEN PERITONEAL DRAINAGE FOR THE MANAGEMENT OFSEPTIC PERITONITIS

摘要

Several surgical methods are described for the treatment of generalized septic peritonitis in veterinary medicine, yet controversy exists as to what method is most effective. In general, treatment of septic peritonitis is directed toward the correction of fluid and electrolyte abnormalities, appropriate antimicrobial therapy and exploratory celiotomy to determine and surgically correct the underlying cause of the peritonitis. Most authors advocate some form of postoperative peritoneal drainage. Abdominal drains utilizing intermittent or continuous drainage systems or various open peritoneal drainage techniques are most frequently mentioned. Drains vary in their effectiveness, but none are shown to effectively drain the abdominal cavity. Peritoneal drains have several other disadvantages, including early occlusion of the drain by the omentum, fibrin or exudate, and mechanical irritation of the peritoneum. Lastly, drains may facilitate migration of bacteria into the peritoneal cavity. Pancreatic abscesses or focal abscesses can effectively be managed with either Jackson Pratt or Synder hemovac drain. The suction reservoir is emptied at 4- or 6-hour intervals and the volume and character of the fluid that was collected is recorded. The decision to remove drains_is based on a continuous decrease in fluid production and cytologic evidence that the fluid contains only nondegenerative neutrophils without any evidence of intracellular bacteria.