In our particular case with caecum perforation during inguinal hernia repair, fecal peritonitis and septic shock were present. We performed explorative laparotomy via midline incision and found diffuse peritonitis, ischemia of small bowel and right colon, and NF of the RS. Published reports point out that ultrasound, native abdominal x-ray films or CT scanning are very useful Cilengitide chemical structure preoperative diagnostic methods for bowel perforation with diffuse peritonitis, but the exact condition is always discovered intraoperatively [15, 23]. We decided to

apply a combination of antimicrobial therapy that covers aerobes and anaerobes. After we received the results of microbiological analysis, we ordered antibiotics for each causative organism. During the first operation we performed an extensive surgical debridement of the RS, right hemicolectomy, diverting colostomy on the left colon and multiple buy Vactosertib drainages of the infected intra-abdominal fluid collections. There is still controversy about

the optimal surgical management of colonic perforation complicated with peritonitis. Hartmann’s resection has been considered the procedure of choice in cases with diffuse peritonitis and remains a safe technique for Smoothened Agonist price colectomy in a perforated colon, especially in elderly patients with multiple co-morbidities [30, 31]. More recently, some have suggested that primary resection with anastomosis is a modern approach, even in the presence of diffuse peritonitis [30]. After the wound is stabilized with fresh granulation tissue, we could perform a second reconstruction of the AW defects, primarily with advanced flaps and skin grafts. The diverting colostomy was closed in a third operation. HBO therapy The use of HBO as an adjuvant therapy for NSTI is based on animal and human studies, and continues to be the subject of scientific analysis [45]. Several studies have shown decreased morbidity and mortality when HBO is used postoperatively as adjuvant therapy [26, 36, 45]. However,

HBO should not interfere with or delay the repeated surgical debridement. The newest data indicate that oxygen administration in the perioperative Lonafarnib in vivo period may reduce the risk of wound infection [36, 54]. The reason for this is that the ability of neutrophil leucocytes to kill bacteria depends on the oxygen availability and formation of free oxygen radicals. HBO additionally increases oxygen diffusion into soft tissue and facilitates the synthesis of collagen and angiogenesis [54]. Better perfused tissue is more resistant to infection (especially from anaerobic spp.) [55] and exotoxin excretion by Clostridium spp. [56, 57]. We have determined the effect of HBO therapy on short term complications of complex war wounds to the upper and lower extremities that included cases with NSTI and NF in patients who were and patients who were not treated according to the North Atlantic Treaty Organization (NATO) emergency war surgery recommendations [36].