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Kirurgija » | Latest edition »

Management of Acute Intra-Abdominal Infections

 

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Intra-abdominal infections encompass all forms of bacterial peritonitis, intra-abdominal abscesses and infections of intra-abdominal organs. They are subcategorized in two groups: uncomplicated and complicated. Complicated infections often result in peritonitis, therefore,
source control requires surgical management, supplemented by antibiotics and supportive therapy. In most severe cases, abdominal sepsis occurs; this may be of intraperitoneal or extraperitoneal origin. For patients with gastro-duodenal perforations the most common surgical procedure is gastro-duodenal suture. However, in some cases gastro-duodenal resection is performed. At rare occasions, conservative treatment is the only option. For patients with acute cholecystitis, the therapy of choice is cholecystectomy, with laparoscopic approach becoming more and more frequent. Percutaneous drainage is performed in polymorbid patients with severe peritonitis when surgery is not an option. However, conservative treatment can be employed in uncomplicated cases. For patients with acute appendicitis, management is primarily surgical, utilizing either open or laparoscopic appendectomy. Periappendicular abscesses have to be drained. Uncomplicated cases of acute diverticulitis are treated by antibiotic therapy alone. When this treatment is unsuccessful or complications occur, surgical management is required.

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