A rational stepwise diagnostic approach is a central prerequisite for sufficient treatment of abdominal sepsis. Physical examination results in a substantial grading of absent, local or general tenderness and guarding. If guarding is absent, a stepwise and efficient diagnostic approach is applied according to pain intensity and location. In these cases diagnostic laparoscopy is rarely required. In cases of local tenderness, however, diagnostic and often therapeutic laparoscopy plays a key role when extraabdominal origin of pain and diseases prone to medical treatment have been ruled out. In some cases laparotomy can also be avoided by interventional treatment. In patients with generalized guarding we differentiate between ‘spontaneous’ symptoms and cases of postoperative peritonitis. If signs of generalized abdominal sepsis occur without previous surgery, laparotomy should be performed with minimal diagnostic delay in order to obtain rapid source control. The main diagnostic pitfalls result from postoperative peritonitis. In some cases extensive diagnostic means have to be applied to select the optimal therapeutic procedure and ideal timing. In these cases computed tomography (spiral CT) may prove especially beneficial when it is combined with intravenous, oral or rectal application of contrast medium. Spiral CT with i. v. contrast medium enables the detection of ischemic bowel segments. In sigma diverticulitis quite often only CT with i. v. or rectal application of contrast agent allows for adequately staged therapy. Diagnostic problems in postoperatively persisting or recurrent peritonitis can be reduced by means of a staged relaparotomy.

This content is only available via PDF.
© 2000 S. Karger GmbH, Freiburg
2000
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.