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Operative measures

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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

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