Surgery
doi: 10.25005/2074-0581-2018-20-4-442-447
IMPROVEMENT OF PERITONITIS CLASSIFICATION

A.R. Saraev

Department of Surgical Diseases № 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: Based on the existing classification schemes, to improve and implement the modern classification of peritonitis.

Methods: This research based on the experience of complex diagnostics and surgical treatment of 188 patients with advanced peritonitis treated at the Dushanbe City Emergency Medical Center. Today the classifications of peritonitis available and also have been analyzed and studied.

Results: Clinical manifestations of peritonitis widespread largely depended on the causes of the disease, its stage of progression. Analysis of real clinical practice shows that the terms «sepsis» and «severe sepsis» used interchangeably. Based on the study and literature review, a clinical classification of peritonitis has been developed, in which the stages of its development correspond to both the severity of clinical manifestations and the pathogenesis of peritonitis, which greatly optimizes further tactics and, thereby improves the results of treatment. Clinical comparison of the presented classification with the classification of K.S. Simonyan showed that in fact more often have a toxic phase of peritonitis (partially stages I and II according to our classification) since the reactive stage is more implies that is found in the practice of the surgeon. With regard to the terminal stage, as a final, its isolation is often impractical because in its essence it reflects the final process, i.e. its extreme neglect, which, of course, is not the rule and does not reflect the true statistics of peritonitis.

Conclusion: The developed and presented the classification of peritonitis has both practical and academic significance, and the gradation of the clinical stages of peritonitis is simple, allows you to give an objective assessment of the severity of the patient’s condition, to choose the optimal scheme of surgical treatment and intensive therapy of this difficult category of patients.

Keywords: Intoxication, abdominal sepsis, peritonitis classification.

Download file:

References
  1. Kurbonov KM, Muminov S. Enteral’naya korrektsiya endotoksikoza pri rasprostranyonnom peritonite [Enteral correction of endotoxicosis with a widespread peritonitis]. Vestnik Avitsenny [Avicenna Bulletin]. 2016;1:17-21.
  2. Tskhay VF, Barabash VI, Merzlikin NV, Sorokin RV. Desyatiletniy opyt primeneniya upravlyaemoy laparostomii v lechenii rasprostranyonnogo gnoynogo peritonita [Ten years of experience in the use of controlled laparostomy in the treatment of common purulent peritonitis]. Vestnik khirurgii. 2011;1:54-7.
  3. Daminova NM, Gaziev ZKh, Nazarov MB. Etiopatogenez, klassifikatsiya, diagnostika i lechenie posleoperatsionnogo peritonita [Etiopathogenesis, classification, diagnosis and treatment of postoperative peritonitis]. Zdravookhranenie Tadzhikistana. 2016;4:65-74.
  4. Saenko LS, Tyurin IN, Pryamikov AD, Gelfand BR. Pokazaniya k provedeniyu ekstrakorporal’noy detoksikatsii u bol’nykh s abdominal’nym sepsisom [Indication for carrying out extracorporeal detoxification in patients with abdominal sepsis]. Annaly khirurgii. 2015;1:12-20.
  5. Salamone G, Licari L, Falco N, Augello G, Tutino R, Campanella S, et al. Mannheim Peritonitis Index (MPI) and elderly population: prognostic evaluation in acute secondary peritonitis. Giornale di Chirurgia. 2016;37(6):243-9.
  6. Saraev AR, Kurbonov KM, Polvonov ShK, Khalimov DS. Prognozirovanie iskhoda i vybor lechebnoy taktiki pri rasprostranyonnom peritonite [Prognosis of the outcome and choice of therapeutic tactics in the prevalent peritonitis]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;3:16-9.
  7. Muminov S, Kurbonov KM, Rasulov NA, Kayumov AA. Usovershenstvovanie klassifikatsii zhyolchnogo peritonita [Improvement of classification of bile peritonitis]. Vestnik poslediplomnogo obrazovaniya v sfere zdravookhraneniya. 2015;2:33-7.
  8. Dani T, Ramachandra L, Nair R, Sharma D. Evaluation of prognosis in patients’ with perforation peritonitis using Mannheim’s peritonitis index. International Journal of Scientific and Research Publications. 2015;5(5):1-35.
  9. Kuznetsov NA. Klassifikatsii v meditsine: printsipy postroeniya i klinicheskoe znachenie [Classifications in medicine: principles of construction and clinical significance]. Klinicheskaya meditsina. 2017;5:474-80.
  10. Egiazaryan MI, Akopyan GR, Museyan LA. Sravnenie diagnosticheskoy informativnosti sovremennykh klassifikatsiy sepsisa [Comparison of diagnostic information of modern sepsis classifications]. Vestnik intensivnoy terapii. 2011;2:7-11.
  11. Ibrahim I, Jacobs IG, Webb SA, Finn J. Accuracy of International classification of diseases, 10th revision codes for identifying severe sepsis in patients admitted from the emergency department. Crit Care Resusc. 2012;14(2):112-8.
  12. Pasechnik IN, Skobelev EI, Krylov VV, Salnikov PS, Vershinina MG, Blokhina NV, i dr. Abdominal’nyy sepsis i okislitel’nyy stress [Abdominal sepsis and oxidative stress]. Khirurgiya. 2015;12:18-23.
  13. Gasanov MD. Formirovanie algoritmov dlya opredeleniya stepeni tyazhesti endotoksikoza pri peritonitakh [Formation of algorithms for determining the severity of endotoxicosis in peritonitis]. Khirurgiya. 2015;1:54-7.
  14. Arens C, Kramm T, Decker S, Spannenberger J, Brenner T, Richter DC, et al. Association of immune cell subtypes and phenotype with subsequent invasive candidiasis in patients with abdominal sepsis. Shock. 2018. Available from: http://dx.doi.org/10.1097/SHK.0000000000001251.
  15. Kurbonov KM, Nazirboev KR, Polvonov ShB, Yorov SK. Radikal’noe udalenie istochnika rasprostranyonnogo peritonita u bol’nykh s zabolevaniyami polykh organov [Radical removal of a source of widespread peritonitis in patients with diseases of hollow organs]. Vestnik Avitsenny [Avicenna Bulletin]. 2016;4:24-9.
  16. Rudnov VA, Kulabukhov VV. Sepsis-3: obnovlyonnye klyuchevye polozheniya, potentsial’nye problemy i dal’neyshie prakticheskie shagi [Sepsis-3: updated key provisions, potential problems and further practical steps]. Vestnik anesteziologii i reanimatologii. 2016;4:4-10.
  17. Vincent JL, Opal SM, Marshall JC. Sepsis definitions: time for change. Lancet. 2013;381(9868):774-5.

Authors' information:

Saraev Alisher Rakhmatulloevich,
Candidate of Medical Sciences, Associate Professor of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University

Conflicts of interest: No conflict

Address for correspondence:

Saraev Alisher Rakhmatulloevich

Candidate of Medical Sciences, Associate Professor of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Aveю, 139

Tel.: +992 (918) 650540

E-mail: dr.saraev@mail.ru

Materials on the topic:
  1. FEATURES OF TREATMENT TACTICS FOR PATIENTS WITH «HIGH RISK» ACUTE OBSTRUCTIVE CHOLECYSTITIS
  2. SURGICAL TACTICS IN PATIENTS WITH SPONTANEOUS ESOPHAGUS RUPTURE
  3. INFLAMMATION AND SEPSIS BIOMARKERS IN DIAGNOSIS OF THE GENERALIZED PERITONITIS STAGE
  4. IMPORTANCE OF LABORATORY PARAMETERS IN THE DIAGNOSTICS OF COMPLICATED LIVER ECHINOCOCCOSIS
  5. MINIMALLY INVASIVE SURGERY FOR THE LIVER ECHINOCOCCOSIS
  6. RESULTS OF EMERGENCY LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH HIGH OPERATIONAL RISK
  7. INTUBATION OF THE SMALL INTESTINE AS A COMPONENT OF TREATMENT OF ACUTE STRANGULATED SMALL BOWEL OBSTRUCTION
  8. POSTOPERATIVE PNEUMONIA: PREVENTION AND TREATMENT IN URGENT ABDOMINAL SURGERY
  9. PECULIARITIES OF DIAGNOSTICS, SURGICAL TACTICS AND RESTORATION OPERATIONS IN NECROTIZING INFECTION OF SOFT TISSUES

◄ Back to the list