Pathogenetic mechanisms of enteric insufficiency development in disseminated peritonitis

Disseminated purulent peritonitis is one of the main causes of high mortality in emergency surgery which, with the development of abdominal sepsis, can reach 35–41 %. Secondary peritonitis initiates a cascade of pathophysiological changes in the intestinal system, including intestinal barrier dysfunction, impaired neuroendocrine regulation, and disruption of microbiotic homeostasis. These changes in 85– 100 % of cases naturally lead to the development of enteric insufficiency syndrome (EIS), which is a key pathogenetic factor in the development of abdominal sepsis and multiple organ dysfunction via the “intestine – target organ” mechanism.

In this review article, we analyzed recent open-source studies on the development of enteral insufficiency in secondary peritonitis. We searched the databases of the Scientific Library of Russia (eLibrary.ru, Cyberleninka.ru) and the US National Library of Medicine (PubMed.org, Wiley.com) over the past decade (2014–2024) in Russian and English. The following keywords were used for the search: “peritonitis”, “enteral insufficiency”, “etiology of enteral insufficiency”, “pathogenesis of enteral insufficiency”, and “abdominal sepsis”. The inclusion criteria for the review included studies on the development of enteral insufficiency in inflammatory abdominal diseases and peritonitis. Exclusion criteria for the review: articles containing information on the development of enteral failure in patients with septic, metabolic, and complex nutritional complications typically occurring in patients with inflammatory bowel disease requiring multidisciplinary intervention with metabolic and nutritional support for recovery, as well as enteral failure requiring long-term nutritional support.

This literature review aims are to systematize the current understanding of the pathogenesis of enteral failure syndrome associated with secondary purulent peritonitis, taking into account existing gaps in research. The results of this analysis have practical value for surgeons and specialists in related fields.

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