ABSTRACT
This chapter highlights some of newer work describing direct peritoneal resuscitation to improve intestinal perfusion and facilitate fascial closure. The inflammatory response provides the clinical evidence of signs and symptoms that become the most important means for establishing the diagnosis. Abdominal distention rapidly follows with accompanying nausea, vomiting and paralytic ileus, as the inflammatory process results in the cessation of intestinal peristalsis. An important consideration in making treatment decisions in the patient with peritonitis is the assessment of risk. The American Society of Anesthesiologist (ASA) Classification system has been very valuable in predicting patient outcomes with peritonitis and other emergency surgical interventions. The ASA Classification system has been repeatedly documented to be reasonably accurate in prediction of outcomes. The source of microbial contamination in the acute peritonitis patient must be controlled by excision, plication, diversion or other containment strategies if survival is to be achieved.
