The chapter by Dr. Gloor and colleagues provides a succinct description of the management of diffuse peritonitis. The key principles of surgical intervention, aggressive source control, postoperative lavage, use of the open abdomen technique, planned reexploration if necessary, and antibiotics with intensive care support are certainly cornerstones of treatment. Secondary bacterial peritonitis cannot be considered as a single disease for its causes are legion and approaches to source control highly variable. Mortality from secondary and tertiary peritonitis is related to organ failure, and we found that recurrent infection responds well to repeat source control if not accompanied by organ failure . I would argue whether 20–30 1 of intraoperative lavage is necessary, particularly in light of the study by Fry and colleagues 20 years ago showing that radical peritoneal debridement did not confer benefit . We have never used more than a few (3–41) liters of lavage and there are no prospective trials to justify a particular volume of lavage. Postoperative lavage is also controversial, but makes sense in certain patients. It too has yet to be proven effective in a prospective trial.
KeywordsOrgan Failure Source Control Open Abdomen Prospective Randomized Clinical Trial Invite Commentary