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Table 1 Peritonitis-related complications

From: Vacuum-assisted closure versus on-demand relaparotomy in patients with secondary peritonitis—the VACOR trial: protocol for a randomised controlled trial

Disease-related major morbidity needing readmission and conservative treatment but not surgery
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
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
  1. Reference Table 1: van Ruler O, Mahler CW, Boer KR, Reuland EA, Gooszen HG, Opmeer BC, de Graaf PW, Lamme B, Gerhards MF, Steller EP, van Till JW, de Borgie CJ, Gouma DJ, Reitsma JB, Boermeester MA; Dutch Peritonitis Study Group. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: A randomised trial. JAMA. 2007 Aug 22;298(8):865–72. Available from: http://dx.doi.org/10.1001/jama.298.8.865