Abstract
We attempt to quantify the amount of peritoneal irrigation required to significantly decrease the intraperitoneal bacteria in children with perforated appendicitis, as no ideal volume of peritoneal lavage has yet been determined. A series of 11 children who were operated on for peritonitis caused by perforated appendicitis were reviewed retrospectively. All children were treated with our treatment protocol that included intraoperative peritoneal lavage using a large volume of saline. Peritoneal fluid samples were taken before and after peritoneal lavage and then were cultured to determine the colony counts. Twenty of 24 bacteria were available for evaluation of the changes in the flora counts. We found 85% of species to be resistant to peritoneal lavage when 3–5 l of saline per square meter of body surface area (l/m2) were used. In contrast, 5.8±1.54 l/m2 of peritoneal lavage fluid was necessary to completely eradicate the intraperitoneal bacterial flora. The residual bacteria showed a greater decrease when lavage fluid in excess of 6 l/m2 was used. Although this is only a preliminary report, these findings could be used to justify a true prospective randomized trial in the future.
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Cervantes-Sanchez CR, Gutierrez-Vega R, Vazquez-Carpizo JA, Clark P, Athie-Gutierrez C (2000) Syringe pressure irrigation of subdermic tissue after appendectomy to decrease the incidence of postoperative wound infection. World J Surg 24:38–41, discussion 41–42
Curran TJ, Muenchow SK (1993) The treatment of complicated appendicitis in children using peritoneal drainage: results from a public hospital. J Pediatr Surg 28:204–208
Haecker FM, Berger D, Schumacher U, Friess D, Schweizer P (2000) Peritonitis in childhood: aspects of pathogenesis and therapy. Pediatr Surg Int 16:182–188
Hunt JL (1982) Generalized peritonitis. To irrigate or not to irrigate the abdominal cavity. Arch Surg 117:209-212
Kokoska ER, Silen ML, Tracy TF, Jr., Dillon PA, Cradock TV, Weber TR (1998) Perforated appendicitis in children: risk factors for the development of complications. Surgery 124:619–625, discussion 625–626
Lund DP, Murphy EU (1994) Management of perforated appendicitis in children: a decade of aggressive treatment. J Pediatr Surg 29:1130–1133, discussion 1133–1134
Meller JL, Reyes HM, Loeff DS, Federer L, Hall JR (1991) One-drug versus two-drug antibiotic therapy in pediatric perforated appendicitis: a prospective randomized study. Surgery 110:764–767, discussion 767–768
Minervini S, Bentley S, Youngs D, Alexander-Williams J, Burdon DW, Keighley MR (1980) Prophylactic saline peritoneal lavage in elective colorectal operations. Dis Colon Rectum 23:392-394
Neilson IR, Laberge JM, Nguyen LT, Moir C, Doody D, Sonnino RE, Youssef S, Guttman FM (1990) Appendicitis in children: current therapeutic recommendations. J Pediatr Surg 25:1113–1116
Ohno Y, Kanematsu T (1998) Hyperbaric oxygen therapy for intestinal obstruction in children: an exceptional experience in a compromised child. J Pediatr Surg 33:1543–1545
Schein M, Gecelter G, Freinkel W, Gerding H, Becker PJ (1990) Peritoneal lavage in abdominal sepsis. A controlled clinical study. Arch Surg 125:1132–1135
Sugimoto K, Hirata M, Takishima T, Ohwada T, Shimazu S, Kakita A (1994) Mechanically assisted intraoperative peritoneal lavage for generalized peritonitis as a result of perforation of the upper part of the gastrointestinal tract. J Am Coll Surg 179:443–448
Sugimoto K, Hirata M, Kikuno T, Takishima T, Maekawa K, Ohwada T (1995) Large-volume intraoperative peritoneal lavage with an assistant device for treatment of peritonitis caused by blunt traumatic rupture of the small bowel. J Trauma 39: 689–692
Surana R, Puri P (1994) Primary wound closure after perforated appendicitis in children. Br J Surg 81:440
Toki A, Ogura K, Horimi T, Tokuoka H, Todani T, Watanabe Y, Uemura S, Urushihara N, Noda T, Sato Y, et al. (1995) Peritoneal lavage versus drainage for perforated appendicitis in children. Surg Today 25:207–210
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Ohno, Y., Furui, J. & Kanematsu, T. Treatment strategy when using intraoperative peritoneal lavage for perforated appendicitis in children: a preliminary report. Ped Surgery Int 20, 534–537 (2004). https://doi.org/10.1007/s00383-004-1210-y
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DOI: https://doi.org/10.1007/s00383-004-1210-y