[Results of therapy combining peritoneal lavage and local application of antibiotics in 250 patients with acute perforating appendicitis].

Since 1967, 2480 appendectomies have been performed at the St. Lucas Hospital (Amsterdam) and the St. Annadal Hospital (Maastricht), of which 250 were for perforated appendicitis. A so-called 'combined method' of treatment was used in all these cases: during the operation saline was used to lavage the peritoneal cavity with the patients in the reverse-Trendelenburg position. Antibiotics were left in the peritoneal cavity. No intraperitoneal drainage was performed, but the wound was drained for 5 days. Postoperative treatment consisted of nasogastric suction and parenteral antibiotics for 5 days in combination with anticoagulation. With thus combined approach one death was seen in 250 cases. There were 20 cases of wound infection (8%), 7 pelvic abscesses (2.8%), and 2 retroperitoneal abscesses. No thromboembolic complications were seen because of the use of routine anticoagulation. For 191 patients (77%), total hospitalization was less than 14 days. This method of treatment is compared with recent reports in literature.