Drainage Options for Septic Peritonitis

Septic peritonitis is a rapidly progressing, life-threatening condition characterised by inflammation of the peritoneum, secondary to bacterial contamination of the abdomen¹. Bacterial contamination of the abdomen can occur from various sources such as the gastrointestinal tract, hepatobiliary system, reproductive tract, ruptured abscess, external penetrating injuries or the source may be unknown. Gastrointestinal leakage is by far the most common source of contamination; accounting for 38% to 75% of secondary septic peritonitis cases 2-6and can often occur as a result of surgical wound dehiscence¹.

Septic peritonitis is associated with a high mortality rate in dogs. Successful treatment involves hemodynamic support, surgical exploration to identify and control the source of contamination, and comprehensive postoperative management⁷. Controversy exists on whether the condition is better managed by primary closure, open peritoneal drainage, or closed-suction abdominal drainage. Published survival rates from previous studies have previously suggested there were no significant differences between treatments^5,6, although, because there are no randomised prospective studies, there may be significant selection bias in these retrospective papers with relatively low numbers reported in the literature. Mortality associated with septic peritonitis is also likely to be multifactorial and identifying specific causes for death is challenging. Studies that have reported on the use of continued abdominal drainage after initial correction of the cause of peritonitis have reported a survival rate of 52-89% using open peritoneal drainage^2,6, 70%- 85%^5,8 for closed-suction abdominal drainage and 54-67% reported using no drainage/primary closure^6,7. [...]