Tertiary Peritonitis: Do we Know it Right?

Abstract

The term ‘tertiary peritonitis’ (TP) is poorly defined and seriously misunderstood. While a subset of researchers have dedicated their life work to defining and understand the pathophysiology of the disease. The others deny TP as a distinct entity. It is an intra-abdominal infection that persists or recurs ≥48 hours following successful and adequate surgical source control. This stands as a distinct entity because of its differences from secondary peritonitis in terms of complex etiopathogenesis, unusual microbiological profile, subtle presentation, and extremely high mortality. An integrated multidisciplinary approach is a basis for the successful management of a patient with TP. Targeted nutritional support, antimicrobial stewardship, well-structured anesthesia and sedation strategy, and timely intervention in cases of organ failures may fast-track patient recovery. Early, planned palliative care medicine consultation is a key element in supporting patient and family-centered care.
The true nature and exact characterization of this disease are still somewhat obscure. Is it a true entity, if yes then what are clinical, microbiological, and biochemical markers that will stamp a clinical entity as TP? Isn’t the defined time limit of 48 hours too early to establish the diagnosis of tertiary peritonitis? Once this is elucidated, perhaps more relevant guidelines for the diagnosis and management can then be drawn