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Drainage abdominal cavity- this is special surgical procedure carried out with the aim of removing purulent contents. Thanks to this, they are created good conditions For normal operation all abdominal organs after surgical operations. What are the features of such a procedure, purpose, main risks?

Purpose of drainage of the abdominal cavity

Any surgical operations in the abdominal cavity are associated with a risk of infection. And to avoid dangerous consequences for humans, drainage is prescribed. This is the main remedy postoperative rehabilitation patient after peritonitis or appendicitis. The procedure is often used in for preventive purposes so as not to cause complications.

During inflammatory processes of the organs of the abdominal cavity, it forms a large number of effusion. It contains not only toxic substances, but also great amount microorganisms. If you do not provide help to such a patient, then inflammatory process will only increase.

In most cases it is used surgical method washing the abdominal cavity. In this case, small tubes are introduced into the cavity, which ensure the washing of the necessary organs and the removal of fluid to the outside. Practice shows that sanitation and drainage of the abdominal cavity are indicated in cases of not only abdominal interventions, but also laparoscopy.

Principles of drainage

During rinsing, a system of tubes is used that penetrates the cavity and ensures the removal of liquid. The drainage system includes the following elements:

• rubber, glass or plastic tubes;
• rubber glove graduates;
• catheters;
• probes;
• cotton and gauze wipes, tampons.

All these items must be exclusively sterile: this is the only way to eliminate bacterial foci in the abdominal cavity. If sterility is not maintained, then there is high risk introduction of a bacterial infection into the cavity.

At purulent infection the use of rubber tubes is impractical. The fact is that they easily and quickly become clogged with purulent contents. In this case, the doctor uses a silicone tube.

Typically, the patient has a tube installed under the lower wall of the diaphragm or at the anterior wall of the stomach. The place where such a tube will be inserted is treated with a disinfectant solution. This is a very important moment: insufficient treatment can increase the risk of infection entering the abdominal cavity.

The clamp should fit very well. Next, the most effective rinsing abdominal cavity. During the procedure, biological fluid is removed from it.

How does the procedure work?

The skin at the sites where the drainage is inserted is dissected by 3–5 cm, depending on how developed the subcutaneous tissue is. fatty tissue. A drainage system is introduced into this place using a special technology. It is immersed between the intestines and the organ being treated. The intestines cannot envelop the drainage, because this leads to an intense adhesive process.

All drainage tubes for removing fluid are fixed with a suture. If this is not done, then it may briefly go into the cavity or, conversely, be removed during dressing.

The period of rinsing the cavity ranges from 2 to 7 days. Only in extreme cases it is possible to install the system for more long time. The tube becomes dirty very quickly and its permeability decreases. As a result of prolonged contact with the intestine, a bedsore can form, so the doctor prefers to remove it as early as possible. Glove drainage can be removed on the 6th, maximum - on the 7th day.

Drainage for appendicitis

The indication for drainage is the formation of purulent exudate, especially if the patient has developed subcutaneous fatty tissue. If after removal vermiform appendix he only develops local inflammation peritoneum, then it is enough to use only silicone tube-glove drainage. It is inserted through the incision made during the appendectomy.

With catarrhal appendicitis, a large amount of serous infiltrate accumulates in the abdominal cavity. It is necessary to introduce a microirrigator and ensure the administration of antibiotics. A gauze swab is inserted in the following cases:

• if an abscess is opened;
• if capillary bleeding cannot be eliminated;
• when the tip of the appendix comes off;
• if the mesentery of the appendix is ​​not sufficiently ligated.

Removal of the tampon occurs on days 4–5, best in stages. It is important to follow all aseptic and antiseptic measures to prevent secondary infection.

Rinsing for inflammation of the gallbladder and pancreas and drainage for peritonitis

Drainage of the space under the liver is necessary after cholecystectomy and other operations associated with inflammation of the gallbladder. For this, the Spasokukotsky method is most often used. Drainage of the abdominal cavity is carried out using a long tube, about 20 cm long and with side holes.

It is also necessary to rinse the subhepatic space after injuries to the liver and pancreas. The gastrohepatic ligament is opened in in rare cases. Its opening is permissible in cases of necrosis individual areas liver and pancreas.

Washing the abdominal cavity in these cases makes it possible to improve the course of the postoperative period in patients after cholecystectomy and prevent the development of peritonitis and spleen diseases.

It is advisable to begin drainage in the abdominal cavity during surgery. It is necessary to choose a system that would provide maximum effective removal pus and serous effusion.

Diffuse peritonitis requires preliminary isolation of unaffected areas of the abdominal cavity using sterile gauze towels and napkins. In any case, a one-time sanitation will not be enough for this, and the washing procedure will need to be repeated.

Drainage with general (spread) peritonitis is much more difficult. Drainage is carried out from 4 points. Silicone, tube-glove are used drainage systems. Microirrigators can be administered for diffuse inflammation of the peritoneum that does not extend to its upper floor.

If the patient experiences peritonitis limited to the pelvic area, systems are introduced to him through the iliac contrapertures. In women, they can be administered using posterior colpotomy methods; in men, this is done through the rectum.

Fluid for lavage and rinsing of retroperitoneal tissue

In case of contamination of the peritoneum, purulent peritonitis and in other cases, drainage is carried out using an isotonic solution of sodium chloride (or furatsilin). It is necessary to rinse until clean water comes out of the tube.

From 0.5 to 1 liter of solution is injected into the abdominal cavity to wash the abdominal organs. This liquid is removed using an electric suction. The right and left subdiaphragmatic space is especially thoroughly washed with this liquid. This is due to the fact that in these areas the accumulation of pus may not be noticed.

Lavage is indicated in cases of damage to the retroperitoneal organs. For this purpose, only silicone tubes are used. Their diameter should be about 12 mm. The preparation of the system and the method of its introduction are similar to other cases. Washing is carried out from the abdominal cavity.

Particular care is taken to wash the fiber around Bladder. It must be carried out in compliance with all antiseptic requirements. Suturing of the peritoneum is carried out using catgut threads with a continuous suture.

Additional Notes

There are practically no contraindications to such a procedure. Its result depends on how well the rules of hygiene and asepsis were observed. All peripheral parts of the system must be changed at least twice a day. Fluid drainage must be carried out throughout the entire time the drainage system is installed.

Before suturing rupture of the intra-abdominal part of the bladder It is necessary to carefully examine the bladder wall from the inside to exclude damage to other parts of it. Ruptures of the extraperitoneal part of the bladder usually have a longitudinal direction, and therefore damage to the wall should be sought by pushing apart the thick folds of the contracted bladder. To do this, a finger is inserted into its cavity, which slides along the back wall and with the help of which the location and size of the defect are determined.

In case of damage only retroperitoneal part of the bladder it should be opened in the area of ​​the anterior wall between the two previously applied holders (this incision is then used to apply an epicystostomy). It is more convenient to perform the revision from the inside, since the peri-vesical tissue on the side of the rupture is sharply infiltrated. After this, the peri-vesical tissue is widely opened in the area of ​​the rupture, the necrotic tissue is removed and a double-row suture is applied to the defect of the bladder without suturing the mucous membrane. Tears located low (at the base of the bladder) are also more convenient to be sutured from the inside.

When suturing bladder ruptures use a double-row suture, and the inner row of sutures is applied without grasping the mucous membrane to avoid crystallization urinary stones at the sites suture material located in the lumen of the bladder.

In men, the operation is completed by applying epicystostomy. For women, you can limit yourself to poses permanent catheter. Drainage of peri-vesical tissue in case of retroperitoneal ruptures is carried out by removing the drainage tube through the counter-aperture on the anterior abdominal wall if constant aspiration can be established. If this is not possible, the peri-vesical tissue should be drained from below through the obturator foramen (according to Buyalsky-McWhorter). If the anterior wall of the bladder is damaged, drainage of the prevesical tissue is indicated.

Sanitation and drainage of the abdominal cavity

Having completed the intervention on damaged organs, it is necessary to quickly and atraumatically remove all clots and blood residues from the abdominal cavity, intestinal contents and urine. To do this, sequentially examine the right and left subphrenic spaces, both lateral canals, the pelvic cavity and, finally, both mesenteric sinuses (on both sides of the mesenteric root small intestine). The liquid contents are removed with an electric suction, and the clots with tuffers. Fixed clots and fibrin are washed off by pouring warm water into the abdominal cavity. isotonic solution sodium chloride or an antiseptic solution and then removing this solution with an electric suction. The temperature of the solution should not be higher than 37-38 °C.

For more effective sanitation one assistant lifts the edges of the laparotomy wound, the second pours 1.5-2 liters of solution into the abdominal cavity at once, and the surgeon “rinses” the intestinal loops for 1-2 minutes and big oil seal in this solution. The procedure is repeated until the washing liquid becomes transparent.

Application for draining the abdominal cavity only gauze pads and napkins are blunder, since this causes injury to the peritoneum, which leads to the development adhesive process, damage and infection of the peritoneum.

When draining the abdominal cavity one should take into account the distribution of infected fluid and its possible accumulation, and be guided by the anatomical topography of the peritoneum. Thus, in case of trauma to the abdominal organs, not complicated by peritonitis, one drain is brought to the area of ​​the sutured injury or the resection zone, the second is inserted into the corresponding lateral canal or into the small pelvis.

In case of peritonitis, drain pelvic cavity, lateral canals and subphrenic space on the right and/or left.

Abdominal drains must be removed only through separate punctures abdominal wall. They do it as follows. Based on the expected position of the drainage (make sure that the drainage does not bend sharply when passing through the abdominal wall), the surgeon pierces the skin with a pointed scalpel, and then, replacing the scalpel with a hemostatic clamp, pierces the entire thickness of the abdominal wall with a clamp from the outside inward and obliquely in the direction of the drainage. At the same time, another with a hand inserted into the abdominal cavity to the puncture site, the surgeon protects the intestinal loops from damage by the clamp. The obliquely cut outer end of the drainage is grabbed with a clamp from the side of the abdominal cavity and removed along the required length, controlling the position of the drainage and its side holes with the hand in the abdominal cavity. Each drainage tube must be securely fixed with a strong ligature to the anterior abdominal wall, since accidental and premature loss drainage may cause serious problems V further treatment the victim.

Drainage, excreted from the abdominal cavity, cannot be left open if its length does not allow the outer end of the tube to be immediately lowered below body level. If the drainage tube is short, then at each breathing movement a column of liquid located in the lumen of the drainage moves from the abdominal cavity and into the abdominal cavity, creating all the conditions for its infection. Therefore, the lumen of short drainages is temporarily blocked with clamps or ligatures; such drainages are extended as soon as possible.

For creating effective system drainage the outer end of the drainage should be 30-40 cm below the level of the lowest point of the abdominal cavity.

Nasointestinal intubation.

Laparostomy, program laparosanation.

№ 57. A patient was admitted to the surgical clinic and diagnosed with perforated appendicitis, complicated by widespread peritonitis.

1. What access will you use? mid-lower median laparotomy

2. How is the stump of the appendage treated in conditions of typhlitis? As a rule, when the wall of the cecum is infiltrated, the application of traditional peritonic sutures becomes not only impracticable, but also dangerous. Most authors in such situations recommend the ligature method of treating the stump of the appendix or peritonization with separate interrupted sutures without prior ligation of the stump of the appendix.

3. What are the methods for sanitation of the abdominal cavity in case of peritonitis?

A method of intraoperative flow-through sanitation of the abdominal cavity for diffuse peritonitis, which consists of installing drains after eliminating the source of peritonitis, but before washing the abdominal cavity.

A method for intraoperative sanitation of the abdominal cavity during peritonitis with saline solution perfused with ozone with an ozone concentration of 1.2 μg/ml. Use uniformly sprayed under a pressure of 60-65 atm. high-steam stream of ozonized saline solution.

A method of combined sanitation of the abdominal cavity with diffuse peritonitis using hypo- and hyperthermic ozonated solutions, which are alternated 2-3 times during surgery.

A method of intraoperative hardware sanitation of the abdominal cavity for diffuse peritonitis using the Geyser apparatus and hyperosmolar polyionic solutions.

5. a method of postoperative sanitation of the abdominal cavity using drainages installed in the upper and lower floors of the abdominal cavity, as well as five multi-perforated irrigation tubes: in the right and left lateral canals, both mesenteric sinuses and zigzag along the small intestine. 3-4 hours after the operation, under pressure, it is injected into the abdominal cavity. antiseptic solution, saturated carbon dioxide. Its removal from the abdominal cavity occurs by gravity, under the pressure of the air cushion that was formed after bubbling CO 2, after which the antihypoxic solution “Mafusol” is injected into the abdominal cavity.

A method of sanitation of the abdominal cavity in the treatment of purulent peritonitis by peritoneosorption with a sorbent saturated with an antibiotic; the drug Algipor is used as a sorbent. Algipor therapeutic dressings are placed in the left lateral canal, the left subdiaphragmatic space and envelop the anastomosis area.

A method of sanitation of the abdominal cavity in case of generalized peritonitis, which consists of supplying oxygen through irrigator tubes installed in the right and left mesenteric sinuses, right and left subdiaphragmatic spaces, removed through a laparotomy. The laparostomy is fed in the opposite direction saline, the discharge of which is carried out through drainage tubes installed in the pelvic cavity, right and left lateral canals.

8. methods of sanitation of the abdominal cavity in the form of relaparotomy “according to the program” and “on demand”. Relaparotomy “on demand” is performed when the process progresses, complications of peritonitis occur: bleeding from the gastrointestinal tract, perforation of a hollow organ, formation of abdominal abscesses, etc. Programmed sanitation of the abdominal cavity along with the presence positive points- This constant control for the condition of the abdominal cavity, have a number of disadvantages. These include the formation intestinal fistulas, relapses of intra-abdominal and gastrointestinal bleeding, long-term intubation of hollow organs and catheterization great vessels, which increases the risk of nasocomial complications, wound healing by secondary intention with the subsequent formation of ventral hernias. When using the above methods, the length of stay of patients in the hospital ranges from 20 to 50 days.

9. a method of sanitation of the abdominal cavity, including washing the abdominal cavity, installing drains and sounding with medium (300 kHz) and low frequency (14.7 kHz) ultrasound. Sounding is carried out both during the operation and during postoperative period through contraperture holes in the abdominal wall. The abdominal cavity is washed with an antiseptic solution. Ultrasound exposure is performed in the postoperative period. In this case, ultrasonic emitters are placed in drainage tubes only for the duration of the simultaneous sonification and their subsequent removal.

4. How will you complete the operation?

Rational completion of the operation (determining indications for drainage or packing of the abdominal cavity; ensuring the implementation of revisions and sanitation of the abdominal cavity using the method of open “interventions” or laparoscopic method.

No. 58. A 37-year-old patient was admitted 12 hours later with repeated vomiting of bile and sharp girdle pain in the upper abdomen. The disease is associated with alcohol intake and fatty foods. On examination: the condition is serious, pallor of the skin, acrocyanosis, the abdomen is swollen, limited participation in breathing, tense and sharply painful in epigastric region. Percussion - shortening of sound in sloping areas of the abdomen. Positive symptoms Blumberg-Shchetkin and Mayo-Robson. Pulse - 96 per minute, weak filling. Blood pressure is 95/60 mm Hg, body temperature is -37.2 °C. Blood leukocytes - 17.0x109/l.

Abscess- a cavity filled with pus, formed during inflammatory melting of tissue. Most often formed in subcutaneous tissue and superficial soft tissues. This process can occur independently or be a consequence of a disease. This development of events occurs due to the entry of pyogenic microbes through damaged skin, mucous membranes or other localizations of ulcers. The inflamed area is limited to the capsule, within protective function body.

Most often the causative agent is mixed flora with streptococci, staphylococci and other bacilli. Sometimes the process is accompanied by a rapid increase in the amount of pus, which, in turn, leads to rupture of the capsule and release of the contents to the outside or melting of the underlying layers of tissue. Therefore, opening the abscesses is mandatory. Main medical rule in this case: where there is pus, there is an incision.

Opening and sanitizing ulcers

There are several known methods for opening ulcers located in surface layers. Before the beginning surgical intervention superficial soft fabrics are covered gauze napkins. This is done to avoid infection of healthy tissue. At open method The cavity is widely opened and drained. When conducting private method A small incision is made, and then a thorough curettage (scraping) of the inner walls is performed. At the next stage, the cleaned and sanitized cavity is drained with a double-lumen tube and thoroughly washed.

There is another method - puncture. This method is used with repeated aspiration, that is, a reduced pressure is created, due to which a suction effect occurs. This action is performed using a needle - syringe. The cavity must be washed with antiseptics and antibiotics are administered. First of all, the abscess is punctured and then dissected using a needle. If the abscess is not cleaned sufficiently, an additional one is made through the main incision.

What is drainage

Drainage is the removal of unwanted and pathological fluids, as well as pus, using catheters, drainage tubes, plates, gauze napkins and turundas. This procedure has been used for a long time, since the times of Galen and Hippocrates. This method allows you to better clean the internal and open cavities, which, in turn, reduces the wound healing time and prevents complications and relapses of the formation of purulent foci.

Possible complications of drainage

• Migration of drainage.
• Leakage of pathological contents along the puncture channel.
• Bleeding.

What is rehabilitation

Sanation (Latin sanatio - treatment) is a system of measures aimed at destroying and cleansing the abscess from pathogenic agents, including in this case- pyogenic bacteria. This procedure is carried out by revision, removal and rinsing of the cavity antibacterial drugs. The whole essence of the procedure is aimed at eliminating complications and relapses, as well as at the speedy restoration of tissue at the site of damage.

All treatment of abscesses is carried out under anesthesia by opening, sanitation and drainage of the abscess cavity. The procedure is carried out only qualified specialist in a medical facility.

Novocaine blockade of reflexogenic zones.

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Optimal access to all parts of the abdominal cavity is provided by a median laparotomy, since depending on the location of the lesion, the abdominal wall wound can be expanded upward or downward. If widespread peritonitis is detected during an operation performed from a different incision, then you should switch to a median laparotomy.

Up to 100.0 ml 0.5% is administered novocaine solution in the area of ​​the celiac trunk, the root of the transverse mesentery, thin and sigmoid colon This ensures a reduction in the need for narcotic analgesics, eliminates reflex vascular spasm, thereby creating conditions for an earlier restoration of peristalsis.

3. Elimination or reliable isolation of the source of peritonitis

In the reactive phase it is possible to carry out radical operations(gastric resection, hemicolectomy) since the likelihood of anastomotic failure is insignificant.

In toxic and terminal cases, the scope of the operation should be minimal - appendectomy, suturing the perforation, resection of the necrotic area of ​​the gastrointestinal tract with the application of entero- or colostomy, or delimitation of the lesion from the free abdominal cavity. All reconstructive operations are transferred to the second stage and performed in more favorable conditions for the patient.

Washing reduces the content of microorganisms in the exudate below a critical level (10 5 microbial bodies in 1 ml), thereby creating favorable conditions to eliminate the infection. Tightly fixed fibrin deposits are not removed due to the risk of deserosis. Removing exudate by wiping with gauze due to trauma serous membrane unacceptable.

The washing liquid must be isotonic. The use of antibiotics does not make sense, since short-term contact with the peritoneum cannot have the desired effect on the peritoneal flora.

Most antiseptics have a cytotoxic effect, which limits their use. An electrochemically activated solution of sodium chloride (0.05% sodium hypochlorite) does not have this drawback; it contains activated chlorine and oxygen, therefore it is especially indicated in the presence of anaerobic flora. Some clinics use ozonated solutions.

In toxic and terminal stages peritonitis, when intestinal paresis becomes independent clinical significance carry out nasogastrointestinal intubation of the small intestine with a vinyl chloride probe.

Length of intubation - 70-90 cm distal to the ligament Treitz. If necessary, the colon is drained through the anus.

In rare cases, a gastro-, jejuno-, or appendicostomy is applied to insert the probe.

In the postoperative period, probe correction of the enteral environment is carried out, including decompression, intestinal lavage, enterosorption and early enteral nutrition. This reduces the permeability of the intestinal barrier to microflora and toxins, leading to early restoration of the functional activity of the gastrointestinal tract.

6. Drainage of the abdominal cavity is carried out using vinyl chloride or rubber tubes, which are brought to the purulent focus and brought out through the shortest route.

In Fig. Option for drainage of the abdominal cavity in case of destructive appendicitis, non-limited local peritovitis. Options for drainage of the abdominal cavity for widespread and general peritonitis [from. VC. Gostishchev “Operative purulent surgery”, M. Medicine, 1996], for lavage.

7. The laparotomy wound is sutured leaving drainage in the subcutaneous fatty tissue.

Treatment of residual infection depends on the technique used to complete the operation. This different ways combating residual (residual) infection, related to methods of drainage of the abdominal cavity, or, more precisely, methods of removing exudate and other infected and toxic contents from the abdominal cavity.

1. Suturing the wound tightly without drainage, hoping that the peritoneum itself will cope with the remaining infection. can be used only for local non-limited serous peritonitis with a non-critical level of bacterial contamination, in the absence of the risk of the formation of abscesses and infiltrates. Under these conditions, the body can suppress the infection itself or with the help of antibiotic therapy.

2. suturing the wound with passive drainage. Drains are also used for local administration of antibiotics.

3. suturing with drainage for lavage (flow-through and fractional). The method is practically not used due to the complexity of correcting protein and electrolyte disturbances and a decrease in effectiveness after 12-24 hours of use.

4. bringing the edges of the wound closer together (semi-closed method) with the installation of drainage back wall br.pol., for dorsoventral lavage with aspiration of flowing fluid through the median wound.

5. bringing the edges of the wound closer together using various devices with repeated revisions and sanitation. We use the term planned laparoscopic debridement. The indication for use is the presence of a pronounced adhesive process in severe forms purulent-fibrinous peritonitis with sub- and decompensation of vital functions important organs. The number of revisions is from 2-3 to 7-8. Interval from 12 to 48 hours.

6. open method (laparostomy according to N.S. Makokha or Steinberg-Mikulich) for the purpose of drainage of exudate through the wound covered with tampons with ointment. When changing tampons, it is possible to monitor the condition of the intestinal loops adjacent to the wound. It should be used in the presence of multiple unformed intestinal fistulas, extensive wound suppuration or phlegmon of the abdominal wall.

GENERAL TREATMENT.

Antibacterial therapy

The most adequate regimen of empirical antibacterial therapy (before microbiological verification of the pathogen and determination of its sensitivity to antibiotics) is a combination of synthetic penicillins (ampicillin) or cephalosporins with an aminoglycoside (gentamicin or vancocin) and metronidazole. This combination acts on almost the entire spectrum of possible pathogens of peritonitis.

Upon receipt of a bacteriological analysis, the appropriate combination of antibiotics is prescribed

Routes of administration:

1) local (intra-abdominal) - through irrigators, drainages (dual-purpose drainage).

a) Intravenous

b) Intra-arterial (intra-aortic, into the celiac trunk, into the mesenteric or omental arteries)

c) Intramuscular (only after restoration of microcirculation)

d) Intraportal - through the recanalized umbilical vein in the round ligament of the liver.

d) Endolymphatic. Anterograde - through microsurgically catheterized peripheral lymphatic vessel on the dorsum of the foot or pulpless inguinal lymph node. Retrograde - through the chest lymphatic duct. Lymphotropic interstitial - through the lymphatic network of the lower leg, retroperitoneal space.

Immune therapy.

Among the drugs that improve the immunoreactive properties of the body, immunoglobulin, antistaphylococcal g-globulin, leukocyte mass, antistaphylococcal plasma, leukinferon - a complex of human interferons and cytokines are used.

The use of pyrogenal, decaris (levamisole), prodigiosan, thymalin and other “drugs that stimulate weakened immunity” in malnourished patients, according to many authors, is contraindicated.

Corrective therapy in the postoperative period

Adequate pain relief.

Along with traditional ways treatment pain syndrome with the help of narcotic analgesics, prolonged epidural analgesia is used local anesthetics, acupuncture, electroanalgesia.

Balanced infusion therapy.

Total the fluid administered to the patient during the day consists of physiological daily needs (1500 ml/m2), water deficiency at the time of calculation and unusual losses due to vomiting, drainage, increased sweating and hyperventilation.

Prevention and treatment of multiple organ failure syndrome

The pathogenetic basis for the development of MOF syndrome is hypoxia and cell hypotrophy due to impaired respiration, macro- and microhemodynamics.

Measures for the prevention and treatment of MODS are:

· Elimination of infectious-toxic source.

· Removal of toxins using efferent surgery methods.

· Ensuring adequate pulmonary ventilation and gas exchange (often long-term mechanical ventilation).

· Stabilization of blood circulation with restoration of blood volume, improvement and maintenance of heart function. Normalization of microcirculation in organs and tissues.

· Correction of protein, electrolyte, acid-base composition of blood.

· Parenteral nutrition.

Restoration of gastrointestinal function

Most effective way restoration of gastrointestinal motility is intestinal decompression with a transnasal probe followed by rinsing it.

Normalization nervous regulation and restoration of intestinal muscle tone is achieved by replenishing protein and electrolyte imbalances. After which it is possible to use anticholinesterase drugs (prozerin, ubretide), ganglion blockers (dimecoline, benzohexonium).

For MOF, the use of forced diuresis, hemodialysis, plasmapheresis, hemofiltration through pig organs (liver, spleen, lungs), mechanical ventilation, and HBO is indicated.

HBOT is capable of stopping all types of hypoxia that develop during peritonitis, helps to accelerate the reduction of bacterial contamination of the peritoneum, and enhances the motor-evacuation function of the intestine.

Hemosorption, lymphosorption, plasmapheresis and other detoxification methods cannot be considered as independent methods of treating peritonitis that provide significant advantages.

It is necessary to place emphasis on the prevention of endotoxemia using methods to combat residual infection ( surgical methods and antibacterial therapy).

Most low indicators mortality is achieved with the use of planned laparosanations (20%).

According to inst. Them. Vishnevsky in the treatment of a homogeneous group of patients with peritonitis of appendicular origin with closed drainage years = 24%, with staged lavage 12%. The frequency of abscesses during dialysis and drainage = 27 and 26.6%, with staged washing - 4%. The frequency of sepsis with staged lavage is 12.2%, with drainage and lavage the same - 31%.