[Early diagnosis of diffuse peritonitis].

Treatment for diffuse peritonitis was applied to 62 patients at the Surgical Clinic of Münster University, between 1983 and mid-1985. Mortality accounted for 46.8 per cent. Therapeutic approaches depended on both clinical patterns and intraoperative findings. Repetitive laparotomy with abdominal lavage and generous drainage was predominant. Only five cases were given treatment with opened abdominal cavity. With early diagnosis and immediate laparotomy, 17.7 per cent of all patients were cured, and no further operation was required. A second operation was necessary for 19.3 per cent, and several laparotomies were needed by another 16.1 per cent. Twenty of the above 62 patients (32.3 per cent) died in spite of several laparotomies. Nine patients (14.5 per cent) had been received in moribund and thus inoperable condition. The mean interval between first and second laparotomies was 5.3 days. Repeated abdominal lavage became necessary in cases in which the start of therapeutic action was delayed to 6.4 days on average. This interval had been 8.3 days for patients who died despite repeated surgery. Early diagnosis was found to be the decisive prerequisite to lower peritonitis lethality. Clinical parameters in conjunction with routine laboratory checks have proved to be sufficient for adequate diagnosis in 95 per cent of all cases. High-risk patients have to be identified long time in advance. They require early surgery and intensive postoperative supervision and monitoring, if the fatal vicious circle of peritonitis is to be overcome.