SIRS, MODS and tertiary peritonitis.

Some patients with peritonitis develop a septic response without a detectable infective focus. It is suggested that an immunological dysfunction is responsible for this so called tertiary peritonitis. The role of the gastrointestinal tract in the development of multiple organ dysfunction syndrome (MODS) is discussed. In patients with tertiary peritonitis treatment should be directed towards restoration of the immunological balance, which is probably more important than the elimination of microorganisms with antibiotics.