Perioperative management of septic peritonitis in small animals: A review

TL;DR

This review summarizes the best practices for managing septic peritonitis in dogs and cats during and after surgery, emphasizing the need for more consistent research.

Contribution

The paper provides a comprehensive synthesis of current evidence and highlights gaps in the management of septic peritonitis in small animals.

Findings

Fluid resuscitation with balanced crystalloids and antimicrobial therapy are key for initial stabilization.

Early enteral nutrition is linked to increased survival in postoperative management.

Recurrent SP after surgery is associated with high mortality and requires close monitoring.

Abstract

Septic peritonitis (SP) is a complex, life‐threatening disease, driven by peritoneal inflammation and microbial contamination, requiring timely and dynamic perioperative management.

The aim of this review was to synthesize current knowledge on the perioperative management of SP in dogs and cats.

Evidence‐based strategies for initial stabilization include fluid resuscitation with balanced crystalloids, asopressors, and antimicrobial therapy targeting polymicrobial infections. Anesthetic management should prioritize hemodynamic stability and a multimodal approach to analgesia. Postoperative management should include early enteral nutrition (which is associated with increased survival) and monitoring and treatment of coagulation derangements. Patients should be closely monitored for recurrent SP after surgery, which is associated with high mortality. Evidence for risk factors of dehiscence such as hypoalbuminemia and interoperative hypotension is inconsistently found in studies. Other potential complications include hospital acquired infection and intra‐abdominal hypertension.

There is significant variation in the treatment approach for small animals with SP, likely due to gaps in evidence. Reported survival rates vary widely between studies due to diverse and inconsistent study populations, highlighting the need for further research to optimize care in veterinary patients.

Figures