Table 1 Peritonitis-related complications
Disease-related major morbidity needing readmission and conservative treatment but not surgery |
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Fistula: non-anatomical connection between intestine and cutis, communication between GI tract and external atmosphere or between 2 hollow organs |
Wound dehiscence/incisional hernia with obstruction: full-thickness discontinuity in the abdominal wall with bulging of abdominal content |
Abscess needing percutaneous drainage: pus-containing non-pre-existing cavity confirmed by positive Gram stain or culture |
Renal failure: urine production < 500 mL/24 h with rising levels of blood urea nitrogen and creatinine combined with dehydration (decreased circulating volume with elevated haematocrit needing intravenous rehydration) based on inadequate oral intake, nausea/vomiting, or both (only when needing readmission) |
Myocardial infarction (electrocardiogram and enzyme changes suggestive of myocardial infarction or needing admission to coronary care unit), pulmonary embolus (ventilation-perfusion mismatch on lung scintigraphy), or cerebrovascular accident (ischemic or non-ischemic with persistent paresis or paralysis without previous history) |
Gastric or duodenal bleeding: needing endoscopic treatment or embolisation therapy |
Respiratory failure due to pneumonia, pleural effusion, or pulmonary oedema and needing oxygen therapy or mechanical ventilation |
Urosepsis: urinary tract infection with positive urine and blood cultures and circulatory shock |
Disease-related major morbidity needing surgical intervention during first admission or readmission |
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Incisional hernia: full-thickness discontinuity in abdominal wall with bulging of abdominal contents with or without obstruction with disabling concerns interfering with daily activities |
Bowel obstruction or herniation due to intra-abdominal adhesions: diagnosis must be confirmed during surgery |
Burst abdomen: complete midline or transverse discontinuity in abdominal wall |
Abdominal compartment syndrome: intra-abdominal hypertension ≥ 25 mm Hg with tense abdomen and with increasing respiratory failure, renal failure, or both, measured by the urinary bladder pressure method (modified Burch criteria) |
Fistula: non-anatomical connection between intestine and cutis, communication between GI tract and external atmosphere or between 2 hollow organs |
Intra-abdominal bleeding: only when septic bleeding after index laparotomy or relaparotomy or surgical bleeding after relaparotomy but not after index laparotomy |
Intra-abdominal haematoma needing surgical evacuation |
Perforation of visceral organ confirmed at surgery |
Anastomotic leakage: anastomotic leak on contrast imaging needing surgery or contrast-enhanced computed tomography scan, confirmed at relaparotomy |
Ischemia or necrosis of a visceral organ: critically reduced blood flow to an intra-abdominal organ causing tissue loss, confirmed at pathological examination |
Enterostomy dysfunction due to prolapse, stenosis, or retraction |
Gastric or duodenal ulcer bleeding needing intervention of any type |