The biology of peritonitis and implications for treatment

Peritonitis continues to be one of the major infectious problems confronting surgeons. Despite the many advances in antimicrobial agents and supportive care, the mortality rate of diffuse suppurative peritonitis remains unacceptably high. It is only by thoroughly understanding the basic pathophysiology involved that we can hope to gain insight into potential new avenues of treatment. First, we will review the anatomy and defense capabilities of the peritoneal cavity and relate this knowledge to experimental peritonitis. Next, we will focus on the polymicrobial nature of peritonitis and how, through microbial interactions with host defenses, there is either resolution or persistent infection. Finally, we will consider possible infection-potentiating agents in the peritoneal cavity and then experimental modes of therapy.