operative measures
Last reviewed 01/2018
There are several contentious issues in the operative management of generalised peritonitis:
- incision: a long midline incision provides ample access to most perforation sites and allows ready toilet.
- source of contamination:
- appendicectomy for acute appendicitis
- cholecystectomy for perforation of acute cholecystitis
- oversew peptic ulcers
- in perforated diverticular disease and faecal ulceration, one approach is colonic resection, e.g. Hartmann's resection, +/- raising of a stoma, e.g. Paul-Mickulicz double-ended colostomy; when a single perforated diverticulum is found, trimming, suturing and drainage may be adequate steps
- in perforation secondary to fulminant colitis, the whole colon is usually severely ulcerated and a total colectomy with ileostomy is indicated
- peritoneal lavage
- nasogastric intubation is continued until the return of intestinal function
- closure of the wound with non-absorbable sutures