%PDF-1.3 % 3 0 obj << /Length 9239 >> stream BT /F-10 1 Tf 10 0 0 10 85.825 60.3 Tm 0.000 g /GS2 gs -0.0010 Tc 0.0000 Tw (22)Tj 8 0 0 8 85.825 777.4501 Tm 0.0075 Tc (ORD)Tj /F1 1 Tf 2.1334 0 TD 0.0066 Tc 0.1251 Tw [(EZ C., PINED)36.6(A J.)7.8(, )55.4(ARIAS R., BENTEZ F)81.6(.)0.3(, )25.5(TOR)36.6(O L.,)6.6( )55.4(ARISTIZB)40.4(AL G., MAR)62.9(TNEZ J., ROSSO F)81.6(.)0.3(, GRAN)36.6(ADOS M., BADIEL M.)]TJ ET 1.000 g 1 i 68.775 814.350 532.950 -73.700 re f* BT 10 0 0 10 85.825 777.6901 Tm 0.000 g -0.0374 Tc -0.0623 Tw [(AR)61.6(TCULO ORIGIN)40.6(AL)]TJ ET q 545.075 790.050 42.500 -25.300 re W n q 42.5 0 0 25.3 545.075 764.75 cm /Im1 Do Q Q q 18.000 18.000 637.450 821.700 re W n 0.000 G 0 J 0 j 0.51 w 10 M []0 d 85.825 238.965 m 142.525 238.965 l S 1000 M 86.080 136.595 238.990 -41.990 re S Q BT 11 0 0 11 98.815 117.06 Tm 0.0002 Tc -0.0031 Tw (Fecha de recibo: 2 de mayo de 2006)Tj 0 -1.2 TD 0.0003 Tc -0.0124 Tw (Fecha de aprobacin: 30 de marzo de 2008)Tj ET 0.000 G 0 J 0 j 0.51 w 10 M []0 d 85.825 568.695 m 587.575 568.695 l 85.825 540.795 m 587.575 540.795 l S BT /F-11 1 Tf 10 0 0 10 85.525 551.3101 Tm 0.0006 Tc -0.0500 Tw (Palabras clave: )Tj /F1 1 Tf 6.519 0 TD 0.0009 Tc -0.0499 Tw [(peritonitis, evolucin clnica, mortalidad, laparotoma, tcnicas de sutura.)]TJ 8 0 0 8 416.365 777.6 Tm 0.0267 Tc 0.1250 Tw (Rev Colomb Cir 2008;23\(1\):22-30)Tj /F-12 1 Tf 12 0 0 12 181.975 497.85 Tm -0.0011 Tc 0.0000 Tw (Resumen)Tj /F-13 1 Tf 11 0 0 11 85.825 469.86 Tm 0.0100 Tc (Introducci)Tj /F2 1 Tf 4.434 0 TD (n.)Tj /F-11 1 Tf 1.3342 0 TD 0.0104 Tc 0.1250 Tw [( La anastomosis primaria es una t)]TJ /F3 1 Tf 14.7618 0 TD 0.0000 Tw (c-)Tj -20.53 -1.2 TD 0.0021 Tc 0.1250 Tw (nica posible en el manejo de la peritonitis secunda-)Tj T* 0.0248 Tc (ria grave en pacientes crticamente enfermos; sin)Tj T* 0.0004 Tc 0.0485 Tw [(embar)35.9(go, su uso se ha limitado por el riesgo de com-)]TJ T* 0.0112 Tc 0.1250 Tw (plicaciones y muerte.)Tj /F2 1 Tf 0 -2.4 TD 0.0242 Tc 0.1248 Tw (Materiales y mtodos.)Tj /F3 1 Tf 9.7282 0 TD 0.0244 Tc 0.1257 Tw [( Se seleccionar)48.9(on pacientes)]TJ -9.7282 -1.2 TD 0.0158 Tc 0.1248 Tw [(con peritonitis secundaria gr)12.1(ave que r)34.9(equeran r)34.9(e)1.9(-)]TJ T* 0.0005 Tc 0.1050 Tw [(seccin de un se)41.4(gmento del intestino y se manejar)46.9(on)]TJ T* 0.0173 Tc 0.1250 Tw (con ligadura transitoria de intestino con hiladilla,)Tj T* 0.0051 Tc 0.1252 Tw [(abdomen abierto, lapar)46(otomas mltiples pr)46(o)6(g)0.6(r)12.3(ama-)]TJ T* 0.0004 Tc 0.0742 Tw (das y posterior anastomosis primaria diferida. Como)Tj T* 0.0206 Tc 0.1252 Tw (xito primario se defini aquel caso en el cual se)Tj T* 0.0191 Tc 0.1250 Tw (logr hacer la anastomosis y no tuvo filtracin ni)Tj T* 0.0258 Tc 0.0000 Tw (fstula.)Tj /F2 1 Tf 23.8418 19.3582 TD -0.0196 Tc (Resultados.)Tj /F3 1 Tf 4.5355 0 TD -0.0200 Tc 0.1196 Tw [( Se estudiar)48.2(on 26 pacientes. El )15.6(AP)94.5(A)31.9(CHE II)]TJ -4.5355 -1.2 TD -0.0197 Tc 0.0737 Tw [(pr)48.5(omedio fue de 15,3 puntos. Se pr)13(acticar)43(on 14 anasto-)]TJ T* -0.0028 Tc 0.1254 Tw [(mosis enter)49(oentricas, )-17.4(5 anastomosis coloclicas y 4)]TJ T* -0.0050 Tc 0.1250 Tw (anastomosis ileoclicas, y en 3 pacientes no se pudo)Tj T* -0.0176 Tc 0.1251 Tw [(hacer anastomosis. En pr)47.9(omedio, hubo 4 lapar)47.9(otomas)]TJ T* -0.0119 Tc [(mltiples pr)42.6(o)10.8(g)2.6(r)11.6(amadas por paciente que se r)34.5(ealizar)45.4(on)]TJ T* -0.0111 Tc 0.1250 Tw (cada 24 horas antes de la anastomosis.)Tj 0 -2.4 TD 0.0190 Tc (El xito primario se logr en 20 pacientes \(77%\).)Tj 0 -1.2 TD 0.0316 Tc 0.1252 Tw (La supervivencia a los 28 das fue de 88,4%, 23)Tj T* 0.0048 Tc 0.1250 Tw [(pacientes e)43(g)0.3(r)33.8(esar)45.7(on vivos y slo 3 \(11,5%\) fallecie-)]TJ T* 0.0004 Tc 0.0817 Tw [(r)45.8(on en la unidad de cuidados intensivos; estas muer)19.5(-)]TJ T* 0.0147 Tc 0.1251 Tw [(tes fuer)42(on independientes del pr)42(ocedimiento.)]TJ /F2 1 Tf 0 -2.4 TD 0.0129 Tc 0.0000 Tw (Discusin.)Tj /F3 1 Tf 4.4891 0 TD 0.0133 Tc 0.1254 Tw [( En pacientes con peritonitis secundaria)]TJ -4.4891 -1.2 TD 0.0035 Tc 0.1253 Tw [(gr)16.1(ave la estr)11.7(ate)38.9(g)-1(ia de contr)49.9(ol de daos fue viable y)]TJ T* 0.0184 Tc 0.1250 Tw (segura, con un xito primario de 77%, con fstula)Tj T* 0.0065 Tc 0.1257 Tw [(en 11,5%, y mortalidad de 11,5%.)]TJ /F-12 1 Tf 12 0 0 12 436.735 233.19 Tm -0.0335 Tc 0.0000 Tw (Introducci)Tj /F4 1 Tf 4.165 0 TD (n)Tj /F1 1 Tf 11 0 0 11 348.085 205.2 Tm -0.0003 Tc -0.0621 Tw (Los pacientes con peritonitis secundaria grave asociada)Tj 0 -1.2 TD -0.0083 Tc -0.0625 Tw (a estados de sepsis y choque tienen una morbimortalidad)Tj T* 0.0001 Tc 0.0272 Tw (superior al 30% y requieren de diferentes intervencio-)Tj T* 0.0006 Tc 0.0833 Tw (nes en su manejo.)Tj 6.4 0 0 6.4 429.115 169.26 Tm 0.0018 Tc 0.0000 Tw (\(1-4\))Tj 11 0 0 11 441.985 165.6 Tm 0.0004 Tc 0.0841 Tw [( Estos pacientes necesitan abun-)]TJ -8.5364 -1.2 TD 0.0227 Tw (dantes infusiones de lquidos, vasopresores, asistencia)Tj T* -0.0057 Tc -0.0628 Tw (respiratoria mecnica y monitoreo hemodinmico, entre)Tj T* 0.0000 Tc 0.0000 Tw (otros.)Tj 6.4 0 0 6.4 372.835 129.66 Tm 0.0018 Tc (\(5-14\))Tj 11 0 0 11 388.885 126 Tm 0.0002 Tc 0.0489 Tw [( En el abordaje quirrgico de las lesiones de)]TJ -3.7091 -1.2 TD -0.0025 Tc -0.0625 Tw (vsceras huecas, las ostomas del intestino delgado y del)Tj T* 0.0003 Tc 0.0621 Tw (colon han sido tcnicas frecuentemente utilizadas por)Tj 24 0 0 24 167.965 689.64 Tm -0.0004 Tc -0.0454 Tw (Curso clnico de la peritonitis grave)Tj -1.5 -1.2 TD -0.0043 Tc -0.0625 Tw (en pacientes crticamente enfermos tratados)Tj 3.0625 -1.2 TD -0.0004 Tc (con sutura primaria diferida)Tj 11 0 0 11 131.215 606.45 Tm 0.0000 Tc 0.0000 Tw (C)Tj 7.7 0 0 7.7 138.565 606.45 Tm 0.0006 Tc (ARLOS)Tj 11 0 0 11 163.825 606.45 Tm -0.0673 Tc ( A)Tj 7.7 0 0 7.7 173.785 606.45 Tm 0.0012 Tc [(LBER)63.5(T)20(O)]TJ 11 0 0 11 203.125 606.45 Tm -0.0120 Tc ( O)Tj 7.7 0 0 7.7 213.685 606.45 Tm -0.0006 Tc (RDEZ)Tj 11 0 0 11 244.885 606.45 Tm 0.0001 Tc -0.0127 Tw [(, MD*, J)]TJ 7.7 0 0 7.7 283.135 606.45 Tm -0.0010 Tc 0.0000 Tw (AIME)Tj 11 0 0 11 302.785 606.45 Tm -0.0700 Tc ( A)Tj 7.7 0 0 7.7 312.715 606.45 Tm 0.0006 Tc (NDRS)Tj 11 0 0 11 337.975 606.45 Tm -0.0205 Tc ( P)Tj 7.7 0 0 7.7 346.615 606.45 Tm -0.0012 Tc [(INED)37.8(A)]TJ 11 0 0 11 370.225 606.45 Tm 0.0006 Tc -0.0131 Tw [(, MD*, R)]TJ 7.7 0 0 7.7 411.535 606.45 Tm -0.0012 Tc 0.0000 Tw [(AF)68.9(AEL)]TJ 11 0 0 11 435.775 606.45 Tm -0.0120 Tc ( H)Tj 7.7 0 0 7.7 446.335 606.45 Tm 0.0003 Tc [(UMBER)58.7(T)19.1(O)]TJ 11 0 0 11 483.385 606.45 Tm -0.0700 Tc ( A)Tj 7.7 0 0 7.7 493.315 606.45 Tm 0.0004 Tc (RIAS)Tj 11 0 0 11 510.865 606.45 Tm 0.0006 Tc -0.0141 Tw (, MD*,)Tj -33.4582 -1.2 TD 0.0000 Tc 0.0000 Tw (F)Tj 7.7 0 0 7.7 148.915 593.25 Tm -0.0001 Tc (EDERICO)Tj 11 0 0 11 182.275 593.25 Tm -0.0638 Tc ( A)Tj 7.7 0 0 7.7 192.265 593.25 Tm 0.0006 Tc (NDRS)Tj 11 0 0 11 217.525 593.25 Tm -0.0579 Tc ( B)Tj 7.7 0 0 7.7 226.975 593.25 Tm -0.0008 Tc (ENTEZ)Tj 11 0 0 11 253.885 593.25 Tm -0.0004 Tc -0.0623 Tw (, MD*, L)Tj 7.7 0 0 7.7 293.425 593.25 Tm -0.0010 Tc 0.0000 Tw (UIS)Tj 11 0 0 11 305.815 593.25 Tm -0.0646 Tc ( E)Tj 7.7 0 0 7.7 314.575 593.25 Tm -0.0022 Tc (DUARDO)Tj 11 0 0 11 347.425 593.25 Tm -0.0619 Tc ( T)Tj 7.7 0 0 7.7 356.215 593.25 Tm 0.0003 Tc (ORO)Tj 11 0 0 11 372.475 593.25 Tm 0.0001 Tc -0.0623 Tw (, MD*, G)Tj 7.7 0 0 7.7 413.275 593.25 Tm -0.0015 Tc 0.0000 Tw (ONZALO)Tj 11 0 0 11 444.865 593.25 Tm -0.0584 Tc ( A)Tj 7.7 0 0 7.7 454.915 593.25 Tm -0.0001 Tc (RISTIZBAL)Tj 11 0 0 11 499.825 593.25 Tm -0.0009 Tc -0.0614 Tw (, MD*,)Tj -37.26 -1.2 TD 0.0000 Tc 0.0000 Tw (J)Tj 7.7 0 0 7.7 94.285 580.05 Tm -0.0021 Tc (ORGE)Tj 11 0 0 11 115.135 580.05 Tm -0.0646 Tc ( E)Tj 7.7 0 0 7.7 123.835 580.05 Tm -0.0027 Tc [(DU)36.3(ARDO)]TJ 11 0 0 11 156.325 580.05 Tm -0.0617 Tc ( M)Tj 7.7 0 0 7.7 168.175 580.05 Tm -0.0046 Tc [(AR)53.8(TNEZ)]TJ 11 0 0 11 200.485 580.05 Tm -0.0008 Tc -0.0627 Tw [(, MD**,)4.7( F)]TJ 7.7 0 0 7.7 244.825 580.05 Tm -0.0035 Tc 0.0000 Tw [(ERN)31.6(ANDO)]TJ 11 0 0 11 282.025 580.05 Tm -0.0634 Tc ( R)Tj 7.7 0 0 7.7 291.415 580.05 Tm -0.0039 Tc (OSSO)Tj 11 0 0 11 311.035 580.05 Tm -0.0014 Tc -0.0614 Tw [(, MD**, M)]TJ 7.7 0 0 7.7 359.065 580.05 Tm -0.0029 Tc 0.0000 Tw (ARCELA)Tj 11 0 0 11 389.785 580.05 Tm -0.0666 Tc ( G)Tj 7.7 0 0 7.7 399.715 580.05 Tm -0.0027 Tc [(RAN)28.5(ADOS)]TJ 11 0 0 11 436.525 580.05 Tm -0.0013 Tc -0.0600 Tw (, MD**, M)Tj 7.7 0 0 7.7 484.585 580.05 Tm -0.0030 Tc 0.0000 Tw (ARISOL)Tj 11 0 0 11 512.215 580.05 Tm -0.0634 Tc ( B)Tj 7.7 0 0 7.7 521.635 580.05 Tm -0.0046 Tc (ADIEL)Tj 11 0 0 11 544.585 580.05 Tm -0.0027 Tc -0.0618 Tw (, MD***)Tj 9 0 0 9 85.825 224.34 Tm 0.0001 Tc -0.0212 Tw [(*)-1073.2(Servicio de Ciruga General, Fundacin )49.9(V)112.1(alle de Lil, Cali, Co-)]TJ 1.5733 -1.2 TD -0.0223 Tc 0.0000 Tw (lombia)Tj -1.5733 -1.8267 TD 0.0001 Tc -0.0172 Tw [(**)-573.2(Unidad de Cuidado Intensi)30.1(v)20.1(o)6.1( )56.9(Adultos, Fundacin )50.3(V)112.1(alle de Lil,)]TJ 1.5733 -1.2 TD -0.0103 Tc -0.0611 Tw (Cali, Colombia)Tj -1.5733 -1.8267 TD 0.0001 Tc 0.0603 Tw [(***)-73.2(Instituto de In)40.1(v)16.8(estig)6.8(aciones Clnicas de la Fundacin )50(V)112.1(alle de)]TJ 1.5733 -1.2 TD -0.0097 Tc -0.0611 Tw (Lil, Cali, Colombia)Tj ET endstream endobj 4 0 obj << /ProcSet [/PDF /Text /ImageB ] /Font << /F-13 5 0 R /F-12 6 0 R /F-11 7 0 R /F-10 8 0 R /F1 9 0 R /F2 10 0 R /F3 11 0 R /F4 12 0 R >> /XObject << /Im1 13 0 R >> /ExtGState << /GS2 14 0 R >> >> endobj 17 0 obj << /Length 8025 >> stream BT /F1 1 Tf 10 0 0 10 577.585 60.3 Tm 0.000 g /GS2 gs -0.0010 Tc 0.0000 Tw (23)Tj 8 0 0 8 91.825 777.51 Tm 0.0143 Tc 0.1247 Tw [(CURSO CLNICO DE LA PERIT)18.1(ONITIS GRA)141.8(VE EN P)96.8(A)35.1(CIENTES CRTICAMENTE ENFERMOS )21.5(TRA)115.6(T)85.3(ADOS CON SUTURA PRIMARIA...)]TJ 11 0 0 11 85.825 731.85 Tm 0.0104 Tc 0.1005 Tw (los cirujanos, en especial, cuando se enfrentan a un)Tj 0 -1.2 TD 0.0630 Tc 0.5045 Tw [(p)-7.5(a)-7.9(ciente con inestabilidad hemodinmica e)]TJ T* 0.0622 Tc 0.0000 Tw (hipoperfusin.)Tj 6.4 0 0 6.4 159.265 709.11 Tm 0.0642 Tc (\(15-20\))Tj 11 0 0 11 181.315 705.4501 Tm 0.0632 Tc 0.1977 Tw [( Estas ostomas pueden ser)]TJ -8.6809 -1.2 TD 0.0450 Tc 0.1248 Tw [(colostomas, ileostomas y)64.1(,)0.5( en los peores casos,)]TJ T* 0.0003 Tc 0.1085 Tw (yeyunostomas, como parte del manejo en esta etapa)Tj T* -0.0228 Tw (crtica. Sin embargo, en los pacientes que sobreviven a)Tj T* 0.0001 Tc 0.0716 Tw (este periodo crtico inicial, el manejo posterior de las)Tj T* -0.0627 Tw (ostomas tiene unas implicaciones psicolgicas profun-)Tj T* -0.0110 Tc -0.0622 Tw (das, adems de mltiples complicaciones mdicas, como)Tj T* -0.0023 Tc -0.0626 Tw (trastornos de los lquidos y electrolitos, daos de la piel,)Tj T* 0.0004 Tc 0.0236 Tw (invaginacin, estenosis, sangrado y problemas asocia-)Tj T* 0.0002 Tc 0.0191 Tw (dos al cierre de la ostoma.)Tj 6.4 0 0 6.4 204.865 590.3101 Tm 0.0025 Tc 0.0000 Tw (\(21\))Tj 11 0 0 11 99.985 560.25 Tm 0.0003 Tc 0.0006 Tw (La anastomosis primaria ha sido descrita como una)Tj -1.2873 -1.2 TD -0.0010 Tc -0.0625 Tw (tcnica posible en el manejo de la peritonitis secundaria)Tj T* 0.0002 Tc 0.0492 Tw (grave en pacientes crticamente enfermos. Sin embar-)Tj T* 0.0431 Tw (go, su uso se ha limitado por el riesgo de filtraciones,)Tj T* -0.0002 Tc -0.0623 Tw (complicaciones secundarias y muerte. En la mayora de)Tj T* -0.0035 Tc -0.0625 Tw (los casos, el tratamiento estndar en el intestino delgado)Tj T* 0.0005 Tc 0.0278 Tw (es la anastomosis primaria, cuando ste es el causante)Tj T* -0.0049 Tc -0.0623 Tw (de la peritonitis. En situaciones de diverticulitis perfora-)Tj T* 0.0002 Tc -0.0608 Tw (da con peritonitis, la anastomosis primaria es una tcni-)Tj T* 0.0004 Tc 0.0379 Tw (ca viable que depende de la estabilidad del paciente y)Tj T* 0.0001 Tc 0.0697 Tw (del juicio del cirujano.)Tj 6.4 0 0 6.4 187.135 431.91 Tm 0.0017 Tc 0.0000 Tw (\(22-24\))Tj 11 0 0 11 206.365 428.25 Tm 0.0003 Tc 0.0697 Tw [( En los ltimos aos se ha)]TJ -10.9582 -1.2 TD 0.0565 Tw (promovido ms este tipo de anastomosis, en especial,)Tj T* 0.0354 Tw (en lesiones traumticas graves del colon.)Tj 6.4 0 0 6.4 267.565 405.51 Tm 0.0017 Tc 0.0000 Tw (\(25-31\))Tj 11 0 0 11 99.985 375.45 Tm 0.0000 Tc -0.0225 Tw [(El objetivo del presente estudio fue describir los re-)]TJ -1.2873 -1.2 TD 0.0002 Tc 0.0143 Tw [(sultados de la anastomosis primaria diferida, con ciru-)]TJ T* -0.0052 Tw (gas programadas por etapas y sutura primaria diferida)Tj T* -0.0029 Tc -0.0626 Tw [(en la misma hospitalizacin, bajo los principios de la ci-)]TJ T* 0.0001 Tc 0.0233 Tw (ruga de control de daos en trauma, intentando evitar)Tj T* 0.0004 Tc 0.0939 Tw (las ostomas, en pacientes crticamente enfermos con)Tj T* 0.0002 Tc 0.0704 Tw (peritonitis secundaria grave.)Tj 6.4 0 0 6.4 211.765 299.91 Tm 0.0013 Tc 0.0000 Tw (\(3,32-46\))Tj /F4 1 Tf 12 0 0 12 150.835 255.84 Tm 0.0004 Tc 0.0042 Tw (Materiales y mtodos)Tj /F2 1 Tf 11 0 0 11 85.825 227.85 Tm 0.0001 Tc 0.0000 Tw (Pacientes. )Tj /F1 1 Tf 4.4127 0 TD 0.0000 Tc -0.0357 Tw (Entre noviembre del 2000 y mayo del 2004,)Tj -4.4127 -1.2 TD -0.0052 Tc -0.0624 Tw (se adelant un estudio prospectivo, observacional y des-)Tj T* 0.0003 Tc 0.0466 Tw (criptivo de pacientes que ingresaron a urgencias de la)Tj T* 0.0001 Tc -0.0612 Tw [(Fundacin Clnica )52.1(V)108.5(alle de Lil, en Cali, Colombia, con)]TJ T* -0.0625 Tw (diagnstico de peritonitis secundaria grave.)Tj 1.2873 -2.4 TD 0.0260 Tw (Los criterios de inclusin fueron: ingresar a urgen-)Tj -1.2873 -1.2 TD 0.0003 Tc 0.1129 Tw (cias con peritonitis secundaria grave y alteracin del)Tj T* 0.0053 Tc 0.1254 Tw (estado hemodinmico, presentar signos de respuesta)Tj T* 0.0003 Tc -0.0266 Tw (inflamatoria sistmica y sepsis grave o choque sptico,)Tj T* 0.0002 Tc 0.0959 Tw (y ser mayor de 18 aos. Se excluyeron todos los pa-)Tj 23.8418 57.8182 TD 0.0003 Tc 0.0071 Tw (cientes con peritonitis a los cuales se les pudiera reali-)Tj 0 -1.2 TD 0.0001 Tc -0.0142 Tw (zar reparo primario inicial y cierre de cavidad abdomi-)Tj T* -0.0080 Tc -0.0625 Tw (nal y aqullos con peritonitis grave que no sobrevivieron)Tj T* 0.0003 Tc 0.0057 Tw (ms de 24 horas despus de la primera ciruga.)Tj /F2 1 Tf 1.2845 -2.4 TD 0.0000 Tc 0.1000 Tw (Protocolo de manejo. )Tj /F1 1 Tf 9.3 0 TD 0.0005 Tc (Los pacientes se llevaron a)Tj -10.5845 -1.2 TD 0.0003 Tc 0.0813 Tw (ciruga en las primeras 6 horas despus del ingreso a)Tj T* 0.0002 Tc 0.0059 Tw [(urgencias o del diagnstico, luego de una reanimacin)]TJ T* 0.0004 Tc -0.0478 Tw (adecuada. Se resec el segmento de intestino delgado o)Tj T* 0.0001 Tc 0.0506 Tw (colon comprometido y se hizo ligadura transitoria del)Tj T* 0.0091 Tw (intestino proximal y distal con hiladillas, drenaje de la)Tj T* -0.0065 Tc -0.0625 Tw (peritonitis, lavado de la cavidad peritoneal y manejo con)Tj T* 0.0019 Tc 0.1255 Tw [(abdomen abierto, con laparotomas programadas por)]TJ T* -0.0042 Tc -0.0621 Tw (etapas, antibiticos de amplio espectro, asistencia respi-)Tj T* 0.0002 Tc -0.0214 Tw (ratoria mecnica y manejo hemodinmico en la unidad)Tj T* -0.0114 Tc -0.0624 Tw (de cuidados intensivos. Cuando se control la peritonitis,)Tj T* 0.0002 Tc -0.0387 Tw (se hizo una anastomosis primaria diferida latero-lateral)Tj T* 0.0091 Tw (con grapadora lineal GIA 80 \(tcnica de Barcelona\) o,)Tj T* 0.0000 Tc 0.0528 Tw [(de forma manual, con )51.9(V)59.3(icryl 3-0)]TJ /F4 1 Tf 14.0209 0 TD 0.0000 Tw ( )Tj /F1 1 Tf 0.3055 0 TD 0.0003 Tc 0.0548 Tw (sutura continua en)Tj -14.3264 -1.2 TD -0.0091 Tw (un solo plano, si no se tena la grapadora.)Tj 6.4 0 0 6.4 529.465 484.71 Tm 0.0017 Tc 0.0000 Tw (\(47-49\))Tj 11 0 0 11 548.725 481.05 Tm 0.0001 Tc -0.0114 Tw [( Se cerr)]TJ -18.24 -1.2 TD 0.0005 Tc 0.1250 Tw (la laparostoma cuando el edema de las asas y de la)Tj T* -0.0042 Tc -0.0624 Tw (pared haba cedido. Se realiz seguimiento clnico hasta)Tj T* 0.0003 Tc -0.0455 Tw (el egreso del hospital.)Tj /F2 1 Tf 1.2845 -2.4 TD -0.0050 Tc -0.0614 Tw (Anlisis estadstico. )Tj /F1 1 Tf 8.1327 0 TD -0.0621 Tw [(En una base de datos en Excel)]TJ -9.4173 -1.2 TD 0.0003 Tc -0.0447 Tw (se incluyeron las variables sociodemogrficas, las rela-)Tj T* 0.0002 Tc 0.0030 Tw (cionadas con el procedimiento quirrgico, la gravedad)Tj T* 0.0003 Tc -0.0573 Tw (del paciente y la estancia en la unidad de cuidado inten-)Tj T* 0.0010 Tw (sivo, y las que evaluaran la presencia de choque, com-)Tj T* 0.0002 Tc -0.0259 Tw (plicaciones y muerte. Se realiz un anlisis descriptivo)Tj T* -0.0017 Tc -0.0614 Tw [(en Epiinfo v)66.5(.6.2.)]TJ 1.2845 -2.4 TD 0.0002 Tc -0.0424 Tw (Como xito primario se defini aquel caso en el que)Tj -1.2845 -1.2 TD -0.0023 Tc -0.0626 Tw (se lograra hacer la anastomosis y no tuviese filtracin ni)Tj T* -0.0130 Tc 0.0000 Tw (fstula.)Tj /F4 1 Tf 12 0 0 12 439.735 242.64 Tm 0.0023 Tc (Resultados)Tj /F1 1 Tf 11 0 0 11 348.085 215.85 Tm -0.0018 Tc -0.0623 Tw [(Se estudiaron y analizaron 26 pacientes que cumplieron)]TJ T* 0.0004 Tc -0.0319 Tw (los criterios de seleccin.)Tj /F4 1 Tf 12 0 0 12 348.085 162.24 Tm -0.0024 Tc -0.0624 Tw [(Datos demogrficos)]TJ /F1 1 Tf 11 0 0 11 348.085 134.25 Tm 0.0002 Tc -0.0111 Tw (La edad promedio fue de 54,5 aos y la mediana de 52)Tj T* -0.0002 Tc 0.0101 Tw (\(rango 18 a 91\). La mayora, 16 \(61,5%\), fueron hom-)Tj T* -0.0008 Tc -0.0626 Tw (bres. La gravedad de los pacientes se clasific de acuer-)Tj T* 0.0001 Tc -0.0223 Tw [(do con el )57.4(AP)90.1(A)40.3(CHE II y se obtuv)19.2(o un promedio de 15,3)]TJ ET endstream endobj 18 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 9 0 R /F2 10 0 R /F4 12 0 R >> /ExtGState << /GS2 14 0 R >> >> endobj 20 0 obj << /Length 7875 >> stream BT /F1 1 Tf 10 0 0 10 85.825 60.3 Tm 0.000 g /GS2 gs -0.0010 Tc 0.0000 Tw (24)Tj 8 0 0 8 85.825 777.4501 Tm 0.0066 Tc 0.1251 Tw [(ORDEZ C., PINED)36.6(A J.)7.8(, )55.4(ARIAS R., BENTEZ F)81.6(.)0.3(, )25.5(TOR)36.6(O L.,)6.6( )55.4(ARISTIZB)40.4(AL G., MAR)62.9(TNEZ J., ROSSO F)81.6(.)0.3(, GRAN)36.6(ADOS M., BADIEL M.)]TJ 11 0 0 11 85.825 731.85 Tm 0.0002 Tc -0.0333 Tw (puntos y una mediana de 14,5 \(rango de 4 a 29\). Diez y)Tj 0 -1.2 TD 0.0003 Tc 0.0263 Tw (ocho pacientes estuvieron en el rango de 10 a 25 pun-)Tj T* 0.0002 Tc -0.0419 Tw (tos, 7 pacientes tuvieron menos de 10 puntos, 6 pacien-)Tj T* 0.1149 Tw (tes, entre 10 y 15 puntos, 4 pacientes, entre 16 y 20)Tj T* 0.0123 Tw (puntos, 8 pacientes, entre 21 y 25 puntos y 1 paciente,)Tj T* 0.0009 Tw (ms de 25 puntos \(tabla 1\).)Tj 9.2864 -3.6 TD 0.0000 Tc 0.0000 Tw (T)Tj 7.7 0 0 7.7 194.665 626.25 Tm -0.0008 Tc (ABLA)Tj 11 0 0 11 215.635 626.25 Tm -0.0600 Tc ( 1)Tj /F3 1 Tf -10.8327 -1.2 TD 0.0128 Tc 0.1255 Tw (Caractersticas generales de los pacientes con)Tj 1.8736 -1.2 TD 0.0183 Tc 0.1257 Tw (diagnstico de peritonitis, 2000-2004)Tj /F1 1 Tf 9 0 0 9 85.825 575.04 Tm -0.0063 Tc 0.0000 Tw [(Caracterstica)-15749.6(V)]TJ 21.75 0 TD -0.0206 Tc (alor)Tj -21.75 -1.7533 TD 21.2067 Tc [(n2)21206.7(6)]TJ 0 -1.7567 TD 0.0002 Tc -0.0097 Tw [(Edad, promedio DE \(aos\))-8789.8(54,5 )-18.2( )-18.2(20)]TJ T* -0.0036 Tc -0.0619 Tw [(Sexo, hombres \(%\))-13830.3(61,5)]TJ 0 -1.7533 TD 0.0003 Tc 0.0278 Tw (Apache \(%\))Tj 0 -1.2 TD 0.0001 Tc 0.0000 Tw [( 0-10)-19623.2(7)]TJ T* [( 11-25)-18873.2(18)]TJ T* [( 26-35)-19123.2(1)]TJ 0 -1.7567 TD -0.0027 Tc -0.0618 Tw [(Apache, mediana)-14496(14,5)]TJ T* 0.0001 Tc -0.0278 Tw (Nmero de laparotomas)Tj 0 -1.2 TD 0.0003 Tc 0.0067 Tw [( promedio DE)-14409.7(4 3)]TJ T* -0.0096 Tc -0.0611 Tw [( mediana)-18216.3(3)]TJ 0 -1.7533 TD 0.0001 Tc -0.0417 Tw (Estancia hospitalaria, das)Tj 0 -1.2 TD 0.0003 Tc 0.0067 Tw [( promedio DE)-13909.7(27 18)]TJ T* -0.0096 Tc -0.0611 Tw [( mediana)-17966.3(2)-9.6(0)]TJ 0 -1.7567 TD 0.0001 Tc -0.0278 Tw (Estancia en UCI \(das\))Tj 0 -1.2 TD 0.0002 Tc 0.0067 Tw [( promedio DE)-13159.8(17,9 10,5)]TJ T* -0.0096 Tc -0.0611 Tw [( mediana)-17966.3(1)-9.6(4)]TJ 0 -1.7567 TD 0.0000 Tc 0.0278 Tw [(Fstula \(%\))-16826.7(11,5)]TJ 0 -1.7533 TD 0.0001 Tc -0.0278 Tw [(Choque \(%\))-16873.2(77)]TJ 0 -1.7567 TD 0.0000 Tw [(SDRA \(%\))-16909.9(15,4)]TJ T* (Respirador \(das\))Tj 0 -1.2 TD 0.0003 Tc 0.0066 Tw [( promedio DE)-13789.7(9,5 11)]TJ T* -0.0096 Tc -0.0611 Tw [( mediana)-18216.3(6)]TJ 0 -1.7533 TD 0.0001 Tc 0.1112 Tw [(Muerte \(%\))-16576.6(11,5)]TJ 0 -2.4 TD 0.0000 Tc 0.0486 Tw (UCI: unidad de cuidado intensivo; SDRA: sndrome de dificultad)Tj 0 -1.2 TD 0.0001 Tc -0.0139 Tw (respiratoria del adulto)Tj /F4 1 Tf 12 0 0 12 85.825 178.86 Tm -0.0038 Tc -0.0625 Tw (Causa de la peritonitis)Tj /F1 1 Tf 11 0 0 11 85.825 150.84 Tm 0.0029 Tc 0.1253 Tw (La peritonitis fue ocasionada por diferentes tipos de)Tj T* -0.0136 Tc -0.0623 Tw (patologas, la mayora de ellas eran posquirrgicas, como)Tj T* 0.0004 Tc 0.0273 Tw (se resume en la tabla 2.)Tj 33.1282 55.2191 TD 0.0000 Tc 0.0000 Tw (T)Tj 7.7 0 0 7.7 456.925 731.85 Tm -0.0008 Tc (ABLA)Tj 11 0 0 11 477.865 731.85 Tm -0.0600 Tc ( 2)Tj /F3 1 Tf -9.0573 -1.2 TD 0.0152 Tc 0.1253 Tw [(Pr)45.2(ocedimientos quirr)37(gicos r)31.6(ealizados)]TJ 4.9773 -1.2 TD 0.0105 Tc 0.1250 Tw (a los pacientes)Tj /F1 1 Tf 9 0 0 9 348.085 680.64 Tm -0.0098 Tc 0.0000 Tw [(Procedimiento)-5279.8(Diagnstico)-6289.8(Frecuencia)]TJ 0 -1.7533 TD 0.0000 Tc 0.0557 Tw [(Laparotoma por)-4270(Obstruccin )27.9(intestinal)-4400(5)]TJ 0 -1.2 TD 0.0001 Tc -0.0001 Tw [(obstruccin intestinal)-2436.6(con )55.4(perforacin)]TJ 0 -1.7567 TD -0.0032 Tc -0.0610 Tw [(Laparotoma abreviada)-1939.9(Isquemia intestinal)-5736.5(3)]TJ 0 -1.2 TD -0.0012 Tc -0.0450 Tw [(con o sin reseccin)-3521.2(Isquemia )17.6(de )17.6(colon)-6067.9(2)]TJ 0 -1.7567 TD -0.0126 Tc -0.0612 Tw [(Herniorrafia inguinal)-2865.9(Hernia inguinal)-7245.9(2)]TJ 0 -1.2 TD 0.0001 Tc -0.0139 Tw (y reseccin intestinal)Tj 11.02 0 TD -0.0125 Tc 0.0000 Tw (estrangulada)Tj -11.02 -1.2 TD 0.0000 Tc (con anastomosis)Tj 0 -1.7533 TD -0.0115 Tc -0.0611 Tw (Hemicolectoma derecha)Tj 11.02 0 TD 0.0001 Tc -0.0417 Tw [(Neoplasia de colon)-5649.9(2)]TJ -11.02 -1.7567 TD -0.0012 Tc 0.0151 Tw [(Reseccin )77.6(intestinal)-3104.5(Neoplasia de intestino)-4317.9(1)]TJ 0 -1.2 TD 0.0000 Tc 0.0000 Tw (con anastomosis)Tj 0 -1.7567 TD -0.0026 Tc -0.0646 Tw [(Colectoma parcial)-3605.9(Diverticulitis )-39.5(perforada)-3902.6(1)]TJ 0 -1.7533 TD -0.0089 Tc -0.0573 Tw [(Correccin de hernia)-2862.2(Hernia )7.6(diafragmtica)-5075.6(1)]TJ 0 -1.2 TD -0.0207 Tc 0.0000 Tw (diafragmtica)Tj 11.02 0 TD -0.0060 Tc (traumtica)Tj -11.02 -1.7567 TD -0.0065 Tc -0.0603 Tw [(Eventrorrafia con malla)-1776.5(Eventracin)-8489.8(1)]TJ T* -0.0074 Tc -0.0611 Tw [(Legrado uterino)-18010.7(1)]TJ 0 -1.7533 TD -0.0031 Tc 0.0000 Tw [(Cistopexia)-20006.4(1)]TJ 0 -1.7567 TD -0.0026 Tc 0.0397 Tw [(Colectoma )104.3(parcial)-3605.9(Herida por proyectil de)-3819.3(2)]TJ 0 -1.2 TD -0.0016 Tc -0.0632 Tw [(con )-37(ostoma)-6188.3(arma de fuego con lesin)]TJ 11.02 -1.2 TD -0.0031 Tc -0.0611 Tw (de colon)Tj -11.02 -1.7567 TD -0.0019 Tc -0.0628 Tw [(Laparotoma, reseccin)-1771.9(Herida )-92.7(penetrante)-6068.6(3)]TJ 0 -1.2 TD -0.0017 Tc -0.0121 Tw [(intestinal y drenaje)-3438.4(de )52.7(abdomen)]TJ T* 0.0000 Tc 0.0833 Tw (de peritonitis)Tj /F4 1 Tf 12 0 0 12 348.085 341.04 Tm -0.0234 Tc -0.0625 Tw (Ciruga inicial)Tj /F1 1 Tf 11 0 0 11 348.085 313.05 Tm 0.0202 Tc 0.0767 Tw (En la ciruga inicial se hizo reseccin del intestino)Tj T* 0.0195 Tc -0.0041 Tw [(delgad)19.6(o)19.6( e)19.6(n)19.6( 1)19.6(5)19.6( )]TJ 6.0031 0 TD -0.0001 Tc 0.0155 Tw [(\(57,7%\) y en 11 \(42,3%\), algn tipo de)]TJ -6.0031 -1.2 TD 0.0002 Tc -0.0051 Tw (colectoma. Las bocas proximal y distal del intestino y)Tj T* 0.0183 Tc 0.1250 Tw (del colon fueron ligadas con hiladilla. Se dren la)Tj T* 0.0002 Tc -0.0455 Tw (peritonitis y se coloc malla de velcro.)Tj /F4 1 Tf 12 0 0 12 348.085 219.84 Tm -0.0183 Tc -0.0625 Tw (Laparotomas mltiples programadas)Tj /F1 1 Tf 11 0 0 11 348.085 191.85 Tm 0.0002 Tc 0.0715 Tw (En promedio, se hicieron 4 de estas laparotomas por)Tj T* -0.0363 Tw (paciente para lavado de la cavidad abdominal y control)Tj T* -0.0079 Tc -0.0626 Tw (de la peritonitis. En 6 pacientes se requirieron 2, incluida)Tj T* 0.0003 Tc -0.0142 Tw (la de la anastomosis. En 6 se realizaron 4 laparotomas)Tj T* -0.0011 Tc -0.0625 Tw (mltiples y los restantes se distribuyeron de la siguiente)Tj T* 0.0005 Tc 0.1250 Tw (manera: en 3 pacientes, una; en 4 pacientes, 3; en 2)Tj T* 0.0004 Tc -0.0475 Tw (pacientes, 5; en un paciente, 6; y en 4 pacientes, ms de)Tj ET 0.000 G 0 J 0 j 0.51 w 10 M []0 d 1 i 85.825 586.185 m 325.315 586.185 l 85.825 570.045 m 325.315 570.045 l 85.825 554.145 m 325.315 554.145 l 85.825 538.005 m 325.315 538.005 l 85.825 523.005 m 325.315 523.005 l 85.825 474.795 m 325.315 474.795 l 85.825 458.655 m 325.315 458.655 l 85.825 421.815 m 325.315 421.815 l 85.825 384.105 m 325.315 384.105 l 85.825 346.665 m 325.315 346.665 l 85.825 329.295 m 325.315 329.295 l 85.825 314.565 m 325.315 314.565 l 85.825 299.565 m 325.315 299.565 l 85.825 263.055 m 325.315 263.055 l 85.825 247.155 m 325.315 247.155 l 348.085 692.505 m 587.575 692.505 l 348.085 675.495 m 587.575 675.495 l 348.085 648.855 m 587.575 648.855 l 348.085 623.055 m 587.575 623.055 l 348.085 585.345 m 587.575 585.345 l 348.085 570.045 m 587.575 570.045 l 348.085 543.405 m 587.575 543.405 l 348.085 526.395 m 587.575 526.395 l 348.085 500.805 m 587.575 500.805 l 348.085 484.695 m 587.575 484.695 l 348.085 469.095 m 587.575 469.095 l 348.085 452.085 m 587.575 452.085 l 348.085 417.195 m 587.575 417.195 l 348.085 378.405 m 587.575 378.405 l S endstream endobj 21 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 9 0 R /F3 11 0 R /F4 12 0 R >> /ExtGState << /GS2 14 0 R >> >> endobj 23 0 obj << /Length 8431 >> stream BT /F1 1 Tf 10 0 0 10 577.585 60.3 Tm 0.000 g /GS2 gs -0.0010 Tc 0.0000 Tw (25)Tj 8 0 0 8 91.825 777.51 Tm 0.0143 Tc 0.1247 Tw [(CURSO CLNICO DE LA PERIT)18.1(ONITIS GRA)141.8(VE EN P)96.8(A)35.1(CIENTES CRTICAMENTE ENFERMOS )21.5(TRA)115.6(T)85.3(ADOS CON SUTURA PRIMARIA...)]TJ 11 0 0 11 85.825 731.85 Tm -0.0084 Tc -0.0622 Tw (6; en tres de estos ltimos fue imposible el control inicial)Tj 0 -1.2 TD 0.0585 Tc 0.1250 Tw (de la peritonitis y se hizo una ileostoma. Las)Tj T* -0.0066 Tc -0.0622 Tw (laparotomas mltiples programadas se hicieron cada 24)Tj T* 0.0004 Tc -0.0030 Tw (horas hasta la ciruga de la anastomosis.)Tj /F4 1 Tf 12 0 0 12 85.825 651.84 Tm -0.0068 Tc -0.0625 Tw (Estancia hospitalaria y asistencia respiratoria)Tj /F1 1 Tf 11 0 0 11 85.825 623.85 Tm -0.0054 Tc -0.0623 Tw (El promedio de das de hospitalizacin fue de 27, con un)Tj T* 0.0002 Tc -0.0467 Tw (rango de 8 a 82 das. La estancia promedio en la unidad)Tj T* -0.0029 Tc -0.0622 Tw (de cuidados intensivos fue de 17,9 das, con un rango de)Tj T* 0.0006 Tc 0.0265 Tw [(6 a 36 das. )19.5(T)85.2(odos los pacientes necesitaron asistencia)]TJ T* 0.0002 Tc 0.0857 Tw (respiratoria mecnica, con un promedio de 10,2 das,)Tj T* -0.0062 Tw (mediana de 7,5, y rango de 1 a 29.)Tj /F4 1 Tf 12 0 0 12 85.825 517.44 Tm -0.0076 Tc 0.0000 Tw (Anastomosis)Tj /F3 1 Tf 11 0 0 11 85.825 489.45 Tm 0.0005 Tc -0.0501 Tw [(T)57.4(ipo de anastomosis posterior)109.6(.)]TJ /F1 1 Tf 12.0873 0 TD 0.0002 Tc -0.0516 Tw [( Se realizaron 14 anasto-)]TJ -12.0873 -1.2 TD 0.0124 Tc 0.1254 Tw (mosis enteroentricas, 5 anastomosis coloclicas, 4)Tj T* 0.0004 Tc 0.0126 Tw (anastomosis ileoclicas y en 3 pacientes no se le pudo)Tj T* -0.0065 Tc -0.0624 Tw (hacer anastomosis por peritonitis terciaria de muy difcil)Tj T* 0.0003 Tc 0.0034 Tw (manejo. Dieciocho anastomosis fueron latero-laterales)Tj T* 0.0262 Tw (con grapadora lineal GIA 80 tcnica de Barcelona y 5)Tj T* 0.0000 Tc 0.0000 Tw (fueron trmino-terminales de forma manual con vicryl)Tj T* 0.0001 Tc 0.0147 Tw (3-0 en un solo plano.)Tj 6.4 0 0 6.4 179.065 400.71 Tm 0.0017 Tc 0.0000 Tw (\(47-49\))Tj /F3 1 Tf 11 0 0 11 99.985 370.65 Tm 0.0076 Tc 0.1250 Tw [(T)56.3(iempo de anastomosis.)]TJ /F1 1 Tf 10.0036 0 TD 0.1246 Tw [( En promedio, la anasto-)]TJ -11.2909 -1.2 TD 0.0002 Tc -0.0102 Tw (mosis se hizo entre el tercero y el cuarto da de la ciru-)Tj T* 0.0003 Tc 0.0009 Tw (ga inicial \(rango de 2 a 15 das\). Estas anastomosis se)Tj T* -0.0471 Tw (realizaron, en un caso, durante la segunda ciruga, doce)Tj T* -0.0159 Tw (anastomosis en la tercera, siete en la cuarta y tres entre)Tj T* 0.0002 Tc 0.0541 Tw (la quinta y la sptima ciruga de lavado de la cavidad)Tj T* 0.0003 Tc 0.0083 Tw (abdominal. Se dej la malla de 2 a 5 das ms despus)Tj T* 0.0005 Tc 0.0579 Tw (de la anastomosis, segn el edema de las asas y de la)Tj T* 0.0002 Tc 0.1175 Tw (pared abdominal. Se realiz una nueva revisin para)Tj T* -0.0083 Tc -0.0623 Tw (verificar la viabilidad de la anastomosis y el control de la)Tj T* 0.0001 Tc -0.0566 Tw (peritonitis. En este procedimiento se retir la malla y se)Tj T* 0.0002 Tc -0.0454 Tw (cerr la cavidad abdominal.)Tj /F4 1 Tf 12 0 0 12 166.585 185.04 Tm -0.0171 Tc 0.0000 Tw (Complicaciones)Tj /F1 1 Tf 11 0 0 11 85.825 157.05 Tm 0.0003 Tc -0.0383 Tw (Las complicaciones en el manejo inicial se presentaron)Tj T* -0.0014 Tc -0.0626 Tw (de la siguiente manera: en 20 pacientes se present cho-)Tj T* 0.0003 Tc 0.0443 Tw [(que sptico que requiri el uso de soporte v)24.8(asopresor)41.2(,)]TJ T* 0.0001 Tc -0.0234 Tw [(principalmente con norepinefrina y)62.8(,)-0.8( en algunas ocasio-)]TJ T* 0.0005 Tc 0.0869 Tw (nes, con vasopresina coadyuvante, a dosis de hasta 3)Tj 23.8418 57.0545 TD 0.0001 Tc 0.0267 Tw (unidades por hora; en cuatro pacientes ocurri sndro-)Tj 0 -1.2 TD 0.0234 Tw (me de dificultad respiratoria del adulto con PaO)Tj 6.4 0 0 6.4 561.025 714.99 Tm 0.0000 Tc 0.0000 Tw (2)Tj 11 0 0 11 564.235 718.65 Tm -0.0004 Tc (/FiO)Tj 6.4 0 0 6.4 584.365 714.99 Tm 0.0000 Tc (2)Tj 11 0 0 11 348.085 705.4501 Tm -0.0182 Tw (menor de 200 mm.)Tj 1.2845 -2.4 TD 0.0003 Tc 0.0704 Tw (En cuanto a las complicaciones del procedimiento)Tj -1.2845 -1.2 TD -0.0020 Tc -0.0625 Tw (definitivo, no se presentaron fugas de la anastomosis, ni)Tj T* 0.0001 Tc -0.0221 Tw (peritonitis residual en 20 pacientes; una filtracin de la)Tj T* 0.0003 Tc -0.0091 Tw (anastomosis del colon cerr en los primeros cinco das)Tj T* 0.0002 Tc -0.0120 Tw (con manejo mdico. Se presentaron dos fstulas del in-)Tj T* -0.0018 Tc -0.0627 Tw (testino delgado, las cuales fueron de difcil manejo y re-)Tj T* 0.0000 Tc 0.0117 Tw (quirieron nutricin parenteral y manejo por el servicio)Tj T* -0.0015 Tc -0.0625 Tw (de terapia enterostomal; finalmente, la fstula cerr en 3)Tj T* 0.0004 Tc -0.0425 Tw [(meses en uno de ellos sin necesidad de ningn procedi-)]TJ T* -0.0063 Tc -0.0627 Tw [(miento quirrgico y en el otro se requiri manejo quirr-)]TJ T* 0.0003 Tc -0.0020 Tw (gico para el control de la fstula cuatro meses despus.)Tj T* 0.0187 Tw [(En catorce pacientes se logr cerrar la f)11.3(ascia, en 11 se)]TJ T* 0.0002 Tc -0.0136 Tw (cerr la piel solamente y uno falleci antes del cierre.)Tj /F4 1 Tf 12 0 0 12 348.085 480.24 Tm -0.0038 Tc -0.0625 Tw (Grmenes ms frecuentes y manejo antibitico)Tj /F1 1 Tf 11 0 0 11 348.085 452.25 Tm 0.0003 Tc 0.0712 Tw (Los principales grmenes encontrados en los cultivos)Tj T* 0.0002 Tc 0.0514 Tw (de la cavidad abdominal se muestran en la tabla 3. El)Tj T* 0.0420 Tc 0.1257 Tw (ms frecuente fue )Tj /F3 1 Tf 8.49 0 TD 0.0425 Tc 0.1227 Tw (Escherichia coli)Tj /F1 1 Tf 7.3282 0 TD 0.0421 Tc 0.1273 Tw (, seguido por)Tj /F3 1 Tf -15.8182 -1.2 TD 0.0245 Tc 0.1227 Tw (Candida albicans)Tj /F1 1 Tf 7.5955 0 TD 0.0232 Tc 0.1273 Tw [( y )]TJ /F3 1 Tf 1.3255 0 TD 0.0249 Tc (Pseudomonas aeruginosa)Tj /F1 1 Tf 10.9773 0 TD 0.0268 Tc (. De)Tj -19.8982 -1.2 TD 0.0004 Tc 0.0222 Tw (los cultivos en sangre, solamente en 4 pacientes se lo-)Tj T* 0.0032 Tc 0.1252 Tw [(gr aislar el germen, en dos, )]TJ /F3 1 Tf 12.4036 0 TD 0.0030 Tc 0.1231 Tw [(P)136.7(.)-0.3( aeruginosa)]TJ /F1 1 Tf 5.64 0 TD 0.0040 Tc 0.1266 Tw (, en uno,)Tj /F3 1 Tf -18.0436 -1.2 TD 0.0049 Tc 0.1228 Tw (Staphylococcus hominis)Tj /F1 1 Tf 9.8673 0 TD 0.0046 Tc 0.1261 Tw [( y en otro, )]TJ /F3 1 Tf 4.8627 0 TD 0.0000 Tw (Alcaligenes)Tj /F1 1 Tf 4.7182 0 TD 0.0059 Tc 0.1272 Tw [( spp.;)]TJ -19.4482 -1.2 TD 0.0002 Tc -0.0613 Tw [(los dems hemocultivos fueron negativos.)]TJ 9.2864 -3.6 TD 0.0000 Tc 0.0000 Tw (T)Tj 7.7 0 0 7.7 456.925 320.25 Tm -0.0008 Tc (ABLA)Tj 11 0 0 11 477.865 320.25 Tm -0.0600 Tc ( 3)Tj /F3 1 Tf -11.2391 -1.2 TD 0.0144 Tc 0.1254 Tw (Grmenes encontrados en la cavidad abdominal)Tj /F1 1 Tf 9 0 0 9 348.085 282.24 Tm -0.0078 Tc 0.0000 Tw [(Germen)-18567.8(Porcentaje)]TJ /F3 1 Tf 0 -2.4 TD -0.0088 Tc -0.0612 Tw (Escherichia coli)Tj /F1 1 Tf 23.31 0 TD 0.0000 Tc 0.0000 Tw (34)Tj /F3 1 Tf -23.31 -1.2 TD -0.0015 Tc -0.0611 Tw (Candida albicans)Tj /F1 1 Tf 23.31 0 TD 0.0000 Tc 0.0000 Tw (11)Tj /F3 1 Tf -23.31 -1.2 TD 0.0278 Tw (Pseudomonas aeruginosa)Tj /F1 1 Tf 23.31 0 TD 0.0000 Tw (23)Tj /F3 1 Tf -23.31 -1.2 TD -0.0063 Tc -0.0611 Tw (Acinetobacter baumanni)Tj /F1 1 Tf 23.31 0 TD 0.0000 Tc 0.0000 Tw (15)Tj /F3 1 Tf -23.31 -1.2 TD -0.0066 Tc -0.0612 Tw (Klebsiella pneumoniae)Tj /F1 1 Tf 23.31 0 TD 0.0000 Tc 0.0000 Tw (11)Tj /F3 1 Tf -23.31 -1.2 TD -0.0076 Tc -0.0611 Tw (Streptococcus faecalis)Tj /F1 1 Tf 23.31 0 TD 0.0000 Tc 0.0000 Tw (15)Tj /F3 1 Tf -23.31 -1.2 TD -0.0556 Tw (Morganella morganii)Tj /F1 1 Tf 23.31 0 TD 0.0000 Tw (11)Tj /F3 1 Tf -23.31 -1.2 TD -0.0069 Tc -0.0611 Tw (Enterococcus faecium)Tj /F1 1 Tf 23.31 0 TD 0.0000 Tc 0.0000 Tw (11)Tj /F3 1 Tf -23.31 -1.2 TD -0.0084 Tc -0.0611 Tw (Enterobacter cloacae)Tj /F1 1 Tf 23.56 0 TD 0.0000 Tc 0.0000 Tw (7)Tj /F3 1 Tf -23.56 -1.2 TD -0.0024 Tc -0.0611 Tw (Staphylococcus aureus)Tj /F1 1 Tf 23.31 0 TD 0.0000 Tc 0.0000 Tw (11)Tj 11 0 0 11 362.215 124.65 Tm 0.0003 Tc 0.0454 Tw (La administracin de los antibiticos se bas en el)Tj -1.2845 -1.2 TD -0.0020 Tc -0.0625 Tw (protocolo establecido en la institucin por el servicio de)Tj T* -0.0071 Tc -0.0621 Tw [(infectologa y)66.5(,)-2.6( posteriormente, se realizaron los cambios)]TJ ET 0.000 G 0 J 0 j 0.51 w 10 M []0 d 1 i 348.085 294.495 m 587.575 294.495 l 348.085 275.805 m 587.575 275.805 l 348.085 155.895 m 587.575 155.895 l S endstream endobj 24 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 9 0 R /F3 11 0 R /F4 12 0 R >> /ExtGState << /GS2 14 0 R >> >> endobj 26 0 obj << /Length 7898 >> stream BT /F1 1 Tf 10 0 0 10 85.825 60.3 Tm 0.000 g /GS2 gs -0.0010 Tc 0.0000 Tw (26)Tj 8 0 0 8 85.825 777.4501 Tm 0.0066 Tc 0.1251 Tw [(ORDEZ C., PINED)36.6(A J.)7.8(, )55.4(ARIAS R., BENTEZ F)81.6(.)0.3(, )25.5(TOR)36.6(O L.,)6.6( )55.4(ARISTIZB)40.4(AL G., MAR)62.9(TNEZ J., ROSSO F)81.6(.)0.3(, GRAN)36.6(ADOS M., BADIEL M.)]TJ 11 0 0 11 85.825 731.85 Tm 0.0004 Tc -0.0117 Tw (de acuerdo con los resultados de los cultivos de sangre)Tj 0 -1.2 TD 0.0222 Tc 0.1253 Tw (y cavidad abdominal. Se inici el tratamiento con)Tj T* 0.0002 Tc -0.0191 Tw (piperazilina/tazobactam o, en su defecto, metronidazol)Tj T* 0.0537 Tw (con cefalosporina de tercera generacin \(cefotaxime\).)Tj T* -0.0127 Tw (Se observ la evolucin de los pacientes y de los culti-)Tj T* 0.0004 Tc -0.0614 Tw (vos, y se cambi la terapia a carbapenem, vancomicina,)Tj T* 0.0383 Tc 0.1250 Tw (antimicticos, ampicilina/sulbactam, trimetoprim)Tj T* -0.0185 Tc -0.0621 Tw (sulfametoxazol, sulperazona o ampicilina, de acuerdo con)Tj T* 0.0002 Tc -0.0500 Tw (la sensibilidad.)Tj 6.4 0 0 6.4 151.315 629.91 Tm 0.0017 Tc 0.0000 Tw (\(50-52\))Tj /F4 1 Tf 12 0 0 12 85.825 585.84 Tm -0.0132 Tc -0.0625 Tw (Tipo de alimentacin)Tj /F1 1 Tf 11 0 0 11 85.825 557.85 Tm 0.0349 Tc -0.0626 Tw [(V)107.8(einte pacientes recibieron nutricin parenteral to-)]TJ T* 0.0400 Tc -0.0625 Tw (tal durante la ligadura intestinal. A 24 pacientes se)Tj T* 0.0515 Tc 0.1254 Tw [(l)-20.3(e)-20.3(s)-16.7( administr nutricin por sonda nasogtrica,)]TJ T* 0.0196 Tc -0.0621 Tw (gastrostoma o yeyunostoma una vez se reestableci)Tj T* 0.0201 Tc -0.0031 Tw (la continuidad intestinal, en un promedio de 24 a 30)Tj T* 0.0350 Tc 0.0000 Tw (horas.)Tj /F4 1 Tf 12 0 0 12 85.825 451.44 Tm -0.0129 Tc -0.0625 Tw (xito primario y supervivencia)Tj /F1 1 Tf 11 0 0 11 85.825 423.45 Tm 0.0225 Tc -0.0621 Tw (La probabilidad de supervivencia hospitalaria fue de)Tj T* 0.0301 Tc 0.0065 Tw (88,4%: 23 pacientes egresaron de la institucin vi-)Tj T* 0.0268 Tc -0.0627 Tw [(v)16.8(os y 3 \(11,5%\) f)10.4(allecieron \(tabla 4\). En un paciente)]TJ T* 0.0529 Tc 0.1254 Tw [(s)-8.6(e)-12.6( realiz laparotoma abreviada por trombosis)]TJ T* 0.0205 Tc 0.1197 Tw (mesentrica segmentaria y se estableci la anasto-)Tj T* 0.0067 Tc -0.0623 Tw (mosis sin complicaciones; 8 das despus presento una)Tj T* 0.0201 Tc 0.0939 Tw (nueva arritmia cardiaca y muri posteriormente. A)Tj T* 0.0136 Tc -0.0625 Tw (una paciente se le realiz anastomosis por vlvulo del)Tj T* 0.0203 Tc -0.0284 Tw (intestino medio y falleci 15 das despus por sepsis)Tj T* 0.0202 Tc -0.0556 Tw (por catter secundario a )Tj /F3 1 Tf 10.0582 0 TD 0.0207 Tc -0.0542 Tw [(P)140.8(.)-0.4( aeruginosa)]TJ /F1 1 Tf 5.6836 0 TD 0.0204 Tc -0.0568 Tw (. Otra paciente)Tj -15.7418 -1.2 TD 0.0239 Tc 0.1250 Tw (falleci por peritonitis no controlada secundaria a)Tj T* 0.0202 Tc 0.0262 Tw (fstulas intestinales mltiples. En la tabla 3 se resu-)Tj T* 0.0206 Tc -0.0250 Tw (men estos hallazgos.)Tj 9.2864 -3.6 TD 0.0000 Tc 0.0000 Tw (T)Tj 7.7 0 0 7.7 194.665 225.45 Tm -0.0008 Tc (ABLA)Tj 11 0 0 11 215.635 225.45 Tm -0.0600 Tc ( 4)Tj /F3 1 Tf -7.2191 -1.2 TD 0.0117 Tc 0.1258 Tw [(F)58.2(r)32.5(ecuencia de xito primario,)]TJ -1.4318 -1.2 TD 0.0121 Tc 0.1257 Tw (complicaciones y mortalidad \(n=26\))Tj /F1 1 Tf 9 0 0 9 85.825 174.24 Tm 0.0000 Tc 0.0000 Tw (Resultado)Tj 15.1933 0 TD -0.0106 Tc [(Frecuencia)-2423.9(Porcentaje)]TJ -15.1933 -1.7533 TD -0.0030 Tc -0.0619 Tw [(xito primario)-11203(20)-5303(77)]TJ 0 -1.2 TD 0.0000 Tc 0.0463 Tw [(Fstula posterior a anastomosis)-4950(3)-5300(11,5)]TJ T* 0.0029 Tc 0.0000 Tw [(Ostoma)-14030.4(3)-5297.1(11,5)]TJ T* 0.0001 Tc [(Mortalidad a 28 das)-9199.9(3)-5299.9(11,5)]TJ /F4 1 Tf 12 0 0 12 443.485 731.04 Tm -0.0062 Tc (Discusin)Tj /F1 1 Tf 11 0 0 11 348.085 703.05 Tm 0.0006 Tc 0.0727 Tw (El manejo de lesiones de vsceras huecas asociadas a)Tj T* 0.0074 Tc 0.1253 Tw (peritonitis se ha hecho clsicamente de dos formas:)Tj T* -0.0024 Tc -0.0621 Tw (anastomosis primaria durante el procedimiento inicial o)Tj T* 0.0028 Tc 0.1250 Tw (realizacin de una ostoma. La decisin de usar una)Tj T* -0.0007 Tc -0.0624 Tw (ostoma o sutura primaria se basa fundamentalmente en)Tj T* 0.0002 Tc 0.0303 Tw (tres factores: el estado hemodinmico, el compromiso)Tj T* -0.0018 Tc -0.0625 Tw (de la cavidad peritoneal y la viabilidad del intestino.)Tj 1.2845 -2.4 TD 0.0162 Tc 0.1254 Tw (Cuando hay estabilidad hemodinmica, con una)Tj -1.2845 -1.2 TD 0.0001 Tc -0.0626 Tw (peritonitis leve o moderada, con el intestino en buen es-)Tj T* 0.0003 Tc -0.0580 Tw (tado, sin repercusin local ni sistmica, est indicado el)Tj T* -0.0017 Tc -0.0636 Tw (reparo primario.)Tj 1.2845 -2.4 TD 0.0004 Tc 0.1068 Tw (Las ostomas se realizan cuando hay compromiso)Tj -1.2845 -1.2 TD 0.0000 Tc 0.0150 Tw (importante del intestino con peritonitis grave y difusa,)Tj T* 0.0001 Tc 0.0121 Tw (filtracin de una anastomosis, edema intestinal impor-)Tj T* -0.0033 Tc -0.0628 Tw (tante, peritonitis postoperatoria, desnutricin grave, uso)Tj T* 0.0001 Tc (crnico de esteroides, isquemia mesentrica, inestabili-)Tj T* 0.0005 Tc -0.0378 Tw [(dad hemodinmica asociada y)66(,)-0.4( en ocasiones, durante la)]TJ T* 0.0002 Tc -0.0273 Tw (ciruga de control de daos.)Tj 1.2845 -2.4 TD 0.0005 Tc -0.0009 Tw (Ambas aproximaciones teraputicas se asocian con)Tj -1.2845 -1.2 TD -0.0127 Tc -0.0621 Tw (complicaciones. En la anastomosis primaria, pueden pre-)Tj T* 0.0121 Tc 0.1246 Tw [(sentarse filtracin y fstulas. En )4(25% a 50% de las)]TJ T* 0.0004 Tc 0.0407 Tw [(ostomas de ur)19.5(gencia hay complicaciones y)63.1(,)2.2( debido al)]TJ T* -0.0358 Tw (edema de la pared y a una movilizacin inadecuada del)Tj T* -0.0075 Tc -0.0621 Tw (intestino, puede haber retraccin, filtracin, protrusin o)Tj T* -0.0094 Tc -0.0625 Tw [(herniacin paraostomal. )20.8(T)83.4(ambin se presentan isquemia,)]TJ T* -0.0047 Tc -0.0626 Tw (infeccin y necrosis por bajo flujo, sin contar los efectos)Tj T* -0.0027 Tc -0.0623 Tw (sicolgicos y las complicaciones derivadas del cierre de)Tj T* 0.0003 Tc 0.1136 Tw (la ostoma.)Tj 6.4 0 0 6.4 397.615 310.71 Tm 0.0007 Tc 0.0000 Tw (\(21,23\))Tj 11 0 0 11 362.215 280.65 Tm 0.0004 Tc (Con respecto al colon, se ha tenido ms precaucin)Tj -1.2845 -1.2 TD 0.0292 Tw (en la realizacin de reseccin y anastomosis primaria,)Tj T* -0.0028 Tw (aunque la tendencia actual es evitar las colostomas en)Tj T* -0.0272 Tw (el paciente con choque y con lesiones asociadas, inclu-)Tj T* 0.0001 Tc 0.0306 Tw (so cuando hay contaminacin fecal importante. La in-)Tj T* 0.0002 Tc -0.0058 Tw [(feccin intraabdominal despus de un trauma grave de)]TJ T* -0.0117 Tc -0.0621 Tw (colon es independiente del procedimiento quirrgico que)Tj T* -0.0035 Tc (se haya realizado: colostoma o sutura primaria.)Tj 6.4 0 0 6.4 552.625 191.91 Tm -0.0032 Tc 0.0000 Tw (\(25-27,30,43\))Tj 11 0 0 11 348.085 175.05 Tm 0.0003 Tc 0.0534 Tw (Por esta razn, Demetrades )Tj /F3 1 Tf 11.6891 0 TD 0.0002 Tc 0.0546 Tw (et al)Tj /F1 1 Tf 1.8055 0 TD (. recomiendan la su-)Tj -13.4945 -1.2 TD -0.0124 Tc -0.0621 Tw (tura primaria en este tipo de trauma.)Tj 6.4 0 0 6.4 498.085 165.51 Tm -0.0116 Tc 0.0000 Tw (\(28\))Tj 11 0 0 11 508.435 161.85 Tm -0.0129 Tc -0.0621 Tw [( En la diverticulitis)]TJ -14.5773 -1.2 TD -0.0032 Tc -0.0623 Tw (perforada con abscesos y peritonitis, la anastomosis pri-)Tj T* 0.0004 Tc -0.0409 Tw (maria es una tcnica utilizada y que depende de la esta-)Tj T* 0.0143 Tc 0.1254 Tw (bilidad hemodinmica del paciente y del juicio del)Tj T* -0.0096 Tc 0.0000 Tw (cirujano.)Tj 6.4 0 0 6.4 385.915 112.71 Tm -0.0094 Tc (\(22,53\))Tj 11 0 0 11 404.185 109.05 Tm -0.0099 Tc -0.0625 Tw [( En la peritonitis fecal o purulenta con com-)]TJ ET 0.000 G 0 J 0 j 0.51 w 10 M []0 d 1 i 85.825 169.815 m 325.315 169.815 l 85.825 185.655 m 325.315 185.655 l 85.825 117.255 m 325.315 117.255 l S endstream endobj 27 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 9 0 R /F3 11 0 R /F4 12 0 R >> /ExtGState << /GS2 14 0 R >> >> endobj 29 0 obj << /Length 8757 >> stream BT /F1 1 Tf 10 0 0 10 577.585 60.3 Tm 0.000 g /GS2 gs -0.0010 Tc 0.0000 Tw (27)Tj 8 0 0 8 91.825 777.51 Tm 0.0143 Tc 0.1247 Tw [(CURSO CLNICO DE LA PERIT)18.1(ONITIS GRA)141.8(VE EN P)96.8(A)35.1(CIENTES CRTICAMENTE ENFERMOS )21.5(TRA)115.6(T)85.3(ADOS CON SUTURA PRIMARIA...)]TJ 11 0 0 11 85.825 731.85 Tm -0.0055 Tc -0.0625 Tw (promiso del paciente, no est indicada la sutura primaria)Tj 0 -1.2 TD 0.0577 Tc 0.1253 Tw (y se ha usado regularmente una colostoma de)Tj T* 0.0154 Tc 0.0000 Tw (Hartmann.)Tj 6.4 0 0 6.4 134.065 709.11 Tm 0.0181 Tc (\(17\))Tj 11 0 0 11 99.985 679.05 Tm 0.0002 Tc -0.0545 Tw (En el paciente con inestabilidad hemodinmica y un)Tj -1.2873 -1.2 TD -0.0030 Tc -0.0621 Tw (proceso inflamatorio agudo, se recomienda disminuir el)Tj T* 0.0002 Tc -0.0020 Tw (tiempo quirrgico, las disecciones amplias y las prdi-)Tj T* 0.0269 Tc 0.1253 Tw (das sanguneas, para evitar un gran porcentaje de)Tj T* -0.0026 Tc -0.0637 Tw (complicaciones posteriores.)Tj 1.2873 -2.4 TD 0.0001 Tc 0.0818 Tw (El intentar una sutura primaria en este tipo de pa-)Tj -1.2873 -1.2 TD 0.0003 Tc 0.0475 Tw (cientes, adems de ir en contra de las anteriores reco-)Tj T* 0.0319 Tc 0.1250 Tw (mendaciones, tiene un mayor riesgo de filtracin)Tj T* 0.0002 Tc 0.0172 Tw [(posterior)43.8(, lo que sera como un se)13.8(gundo golpe para un)]TJ T* 0.0194 Tw (paciente ya comprometido. Por esta razn, se ha reco-)Tj T* -0.0214 Tw (mendado realizar ostomas a cualquier nivel para abre-)Tj T* 0.0003 Tc -0.0273 Tw (viar las cirugas y evitar este tipo de complicaciones.)Tj 1.2873 -2.4 TD -0.0172 Tc -0.0624 Tw (Las complicaciones no slo se deben al procedimiento)Tj -1.2873 -1.2 TD 0.0002 Tc -0.0389 Tw (sino, tambin, a la sepsis derivada de la peritonitis. Los)Tj T* 0.0627 Tc 0.3879 Tw (estudios han demostrado un aumento de la)Tj T* 0.0001 Tc -0.0363 Tw [(morbimortalidad cuando se asocia a )55.3(AP)90.1(A)40.3(CHE II alto, a)]TJ T* -0.0001 Tc -0.0624 Tw (choque sptico, a la necesidad de asistencia respiratoria)Tj T* -0.0137 Tc -0.0625 Tw (mecnica y a sndrome de dificultad respiratoria del adul-)Tj T* 0.0001 Tc 0.0682 Tw [(to. En la sepsis intraabdominal quirr)19.2(gica, si el )54.7(AP)90.1(A-)]TJ T* 0.1132 Tw (CHE II es mayor de 10, la mortalidad es de 32%.)Tj 6.4 0 0 6.4 314.635 405.51 Tm 0.0025 Tc 0.0000 Tw (\(54\))Tj 11 0 0 11 85.825 388.65 Tm 0.0004 Tc 0.1248 Tw [(Con un )54.7(AP)90.4(A)40.6(CHE II de 20, la mortalidad es de 32%)]TJ T* 0.0523 Tc 0.1250 Tw (cuando la sepsis intraabdominal se maneja con)Tj T* 0.0201 Tc 0.1252 Tw [(laparotomas programas por etapas \(ST)91(AR, )]TJ /F3 1 Tf 18.9682 0 TD 0.0196 Tc 0.0000 Tw [(Sta)8.7(g)6.9(e)0.9(d)]TJ -18.9682 -1.2 TD -0.0001 Tc 0.0591 Tw (Abdominal Repair)Tj /F1 1 Tf 7.4182 0 TD 0.0000 Tc 0.0600 Tw (\), en comparacin con una mortali-)Tj -7.4182 -1.2 TD 0.0004 Tc 0.0324 Tw (dad de 54% cuando se hacen laparotomas a demanda)Tj T* -0.0060 Tc -0.0595 Tw [(\(no ST)89.5(AR\).)]TJ 6.4 0 0 6.4 135.475 326.31 Tm -0.0032 Tc 0.0000 Tw (\(3,55\))Tj 11 0 0 11 150.775 322.65 Tm -0.0053 Tc -0.0630 Tw [( Cuando un choque sptico complica una)]TJ -5.9045 -1.2 TD 0.0002 Tc -0.0510 Tw (peritonitis, la mortalidad es de 60%; por otras causas es)Tj T* -0.0003 Tc 0.1000 Tw (menor \(40%\).)Tj 6.4 0 0 6.4 147.985 299.91 Tm 0.0025 Tc 0.0000 Tw (\(56\))Tj 11 0 0 11 158.665 296.25 Tm 0.0003 Tc 0.1009 Tw [( Si se requiere asistencia respiratoria)]TJ -6.6218 -1.2 TD 0.0895 Tw (mecnica por ms de 4 das, se aumenta el riesgo de)Tj T* 0.0001 Tc -0.0431 Tw (neumona asociada al respirador y su morbimortalidad.)Tj T* 0.0266 Tw (Si se complica con sndrome de dificultad respiratoria)Tj T* 0.0002 Tc -0.0131 Tw (del adulto, la mortalidad puede ser hasta de 40%.)Tj 1.2873 -2.4 TD 0.0003 Tc -0.0097 Tw (La idea de la anastomosis primaria diferida nace de)Tj -1.2873 -1.2 TD -0.0377 Tw (la necesidad de otra alternativa de estrategia quirrgica)Tj T* 0.0005 Tc -0.0060 Tw (en el manejo de lesiones de vsceras huecas en pacien-)Tj T* 0.0003 Tc 0.1169 Tw (tes crticamente enfermos. Esta idea fue adaptada de)Tj T* 0.0002 Tc 0.0330 Tw (los conceptos de la estrategia quirrgica de control de)Tj T* 0.0003 Tc 0.0339 Tw (daos en trauma, en la que se hace un abordaje de ur-)Tj T* -0.0071 Tc -0.0626 Tw (gencias inicial y la decisin final sobre el manejo quirr-)Tj T* 0.0100 Tc 0.1252 Tw (gico de las lesiones intestinales se toma una vez el)Tj T* 0.0005 Tc 0.0167 Tw (paciente est clnicamente estable.)Tj 25.1264 56.4 TD -0.0042 Tc -0.0623 Tw (Esta aproximacin quirrgica se ha hecho en pacien-)Tj -1.2845 -1.2 TD 0.0003 Tc -0.0359 Tw (tes inestables por trauma y con ndices elevados de ISS)Tj T* 0.0000 Tc 0.0000 Tw (\()Tj /F3 1 Tf 0.3682 0 TD 0.0381 Tc 0.1254 Tw [(injury se)8.1(verity scor)35.4(e)]TJ /F1 1 Tf 9.1718 0 TD 0.0373 Tc 0.1257 Tw [(\) y )56.3(A)104.8(TI \()]TJ /F3 1 Tf 4.1318 0 TD 0.0381 Tc 0.1273 Tw [(abdominal tr)16.3(auma)]TJ -13.6718 -1.2 TD 0.0005 Tc 0.0000 Tw (index)Tj /F1 1 Tf 2.1682 0 TD 0.0000 Tc 0.0792 Tw (\). La morbilidad reportada en ciruga de control)Tj -2.1682 -1.2 TD 0.0002 Tc 0.0169 Tw [(de daos es de 40% y)65.7(,)-0.7( la mortalidad, hasta de 65%.)]TJ 6.4 0 0 6.4 575.125 682.71 Tm 0.0025 Tc 0.0000 Tw (\(57\))Tj 11 0 0 11 362.215 652.65 Tm 0.0001 Tc -0.0432 Tw (En la ciruga de control de daos en trauma, se utili-)Tj -1.2845 -1.2 TD -0.0060 Tc -0.0625 Tw (zan tcnicas que permiten diferir el manejo definitivo de)Tj T* -0.0016 Tc (una lesin intestinal traumtica. En un primer tiempo se)Tj T* -0.0009 Tc -0.0626 Tw (ligan las bocas proximal y distal con hiladillas o grapas,)Tj T* -0.0053 Tc -0.0625 Tw (lo cual permite controlar la fuga intestinal, sin prolongar)Tj T* 0.0001 Tc -0.0448 Tw (la ciruga inicial y el estrs fisiolgico. 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En)Tj T* 0.1091 Tw (la primera ciruga se reseca el segmento de intestino)Tj T* 0.0002 Tc 0.0818 Tw (delgado o de colon comprometido y se hace ligadura)Tj T* 0.0000 Tc -0.0487 Tw (transitoria del intestino proximal y distal con hiladillas,)Tj T* -0.0015 Tc -0.0625 Tw (drenaje de la peritonitis, lavado de la cavidad peritoneal)Tj T* 0.0001 Tc 0.0227 Tw (y manejo con abdomen abierto, con laparotomas pro-)Tj T* 0.0003 Tc 0.0621 Tw (gramadas por etapas, antibiticos de amplio espectro,)Tj T* -0.0145 Tc -0.0628 Tw (asistencia respiratoria mecnica y manejo hemodinmico)Tj T* -0.0036 Tc -0.0625 Tw (en la unidad de cuidados intensivos. Una vez controlada)Tj T* 0.0001 Tc -0.0340 Tw (la peritonitis, se realiza anastomosis primaria latero-la-)Tj T* 0.0002 Tc -0.0011 Tw (teral con grapadora lineal GIA 80 \(tcnica de Barcelo-)Tj T* -0.0062 Tc -0.0625 Tw [(na\) o, de forma manual, con )51.2(V)58.5(icryl 3-0 sutura continua)]TJ T* 0.0003 Tc 0.0363 Tw (en un solo plano, si no se dispone de la grapadora. Se)Tj T* 0.0091 Tw (cierra la laparotoma cuando el edema de las asas y de)Tj T* 0.0818 Tw (la pared haya cedido.)Tj 6.4 0 0 6.4 444.325 273.51 Tm 0.0017 Tc 0.0000 Tw (\(47-49\))Tj 11 0 0 11 362.215 243.45 Tm 0.0003 Tc 0.1117 Tw (Este reporte presenta el resultado de aplicar estos)Tj -1.2845 -1.2 TD 0.0008 Tc 0.1253 Tw (conceptos en una serie de 26 pacientes consecutivos)Tj T* 0.0000 Tc -0.0195 Tw [(gra)18.5(v)11.8(es, con )54.7(AP)90(A)40.2(CHE II de 15,3 en promedio, con cho-)]TJ T* 0.0004 Tc -0.0520 Tw (que sptico en 77% de los casos, con asistencia respira-)Tj T* 0.0303 Tc 0.1254 Tw (toria mecnica en todos y sndrome de dificultad)Tj T* 0.0003 Tc -0.0193 Tw (respiratoria del adulto en 4 de ellos. Las caractersticas)Tj T* -0.0301 Tw (de estos pacientes predecan un alto nivel de complica-)Tj T* -0.0189 Tc -0.0625 Tw (ciones y mortalidad. Se resec intestino delgado en 57,7%)Tj T* 0.0077 Tc 0.1252 Tw [(y colon \(parcial o total\) en 42,3%. )15.8(T)81.4(odos los cabos)]TJ T* 0.0002 Tc -0.0608 Tw (proximales y distales se ligaron con hiladillas. Se dren)Tj T* 0.0003 Tc -0.0329 Tw (la peritonitis, se lav la cavidad con solucin salina ca-)Tj ET endstream endobj 30 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 9 0 R /F3 11 0 R >> /ExtGState << /GS2 14 0 R >> >> endobj 32 0 obj << /Length 5996 >> stream BT /F1 1 Tf 10 0 0 10 85.825 60.3 Tm 0.000 g /GS2 gs -0.0010 Tc 0.0000 Tw (28)Tj 8 0 0 8 85.825 777.4501 Tm 0.0066 Tc 0.1251 Tw [(ORDEZ C., PINED)36.6(A J.)7.8(, )55.4(ARIAS R., BENTEZ F)81.6(.)0.3(, )25.5(TOR)36.6(O L.,)6.6( )55.4(ARISTIZB)40.4(AL G., MAR)62.9(TNEZ J., ROSSO F)81.6(.)0.3(, GRAN)36.6(ADOS M., BADIEL M.)]TJ 11 0 0 11 85.825 731.85 Tm 0.0303 Tc -0.0051 Tw (liente y se coloc malla de velcro. Se trasladaron a)Tj 0 -1.2 TD 0.0348 Tc 0.1264 Tw [(l)-28.7(a)-28.7( )-27(unidad de cuidados intensivos para monitoreo)]TJ T* 0.0002 Tc 0.0973 Tw (hemodinmico y asistencia respiratoria mecnica. En)Tj T* -0.0109 Tc -0.0622 Tw (promedio, se realizaron 4 laparotomas mltiples progra-)Tj T* 0.0003 Tc 0.0329 Tw (madas para lavado de cavidad abdominal y control de)Tj T* 0.0001 Tc -0.0432 Tw (peritonitis. Cuando la peritonitis se consider controla-)Tj T* -0.0005 Tc -0.0625 Tw (da, se realiz la anastomosis primaria diferida con sutu-)Tj T* 0.0002 Tc 0.0045 Tw (ra mecnica, al tercer o cuarto da de la ciruga inicial.)Tj T* -0.0178 Tw (Se dej abdomen abierto con malla de velcro por dos a)Tj T* -0.0601 Tw [(tres das ms, en promedio, para luego cerrar la cavidad)]TJ T* 0.0003 Tc 0.0064 Tw (abdominal. A la mitad de los pacientes se les pudo ce-)Tj T* 0.0002 Tc 0.0140 Tw (rrar la fascia y la piel; al resto se les cerr la piel sola-)Tj T* 0.0445 Tc 0.1250 Tw (mente. Como complicaciones del procedimiento)Tj T* 0.0002 Tc 0.0790 Tw [(def)16.6(initi)24.7(v)17.5(o)-0.5( se presentaron fstulas en 11,5% de los pa-)]TJ T* -0.0023 Tc -0.0623 Tw (cientes y en 76,9% no se presentaron fugas de la anasto-)Tj T* 0.0001 Tc 0.0500 Tw (mosis, ni peritonitis residual. La supervivencia fue de)Tj T* -0.0075 Tc 0.0000 Tw (88,4%.)Tj 25.1264 19.2 TD 0.0004 Tc 0.0244 Tw (Los resultados de este estudio sugieren que el con-)Tj -1.2845 -1.2 TD 0.0002 Tc -0.0202 Tw (trol de daos en peritonitis grave es una tcnica viable,)Tj T* 0.1182 Tw (resecando el segmento del intestino comprometido y)Tj T* -0.0053 Tc -0.0625 Tw [(l)10.7(i)8.3(gando en forma temporal las bocas con hiladilla, mien-)]TJ T* 0.0102 Tc 0.0870 Tw (tras se controla la peritonitis en cirugas por etapas,)Tj T* 0.0466 Tc 0.1254 Tw [(con )-8(anastomosis primaria diferida, en pacientes)]TJ T* 0.0001 Tc 0.0807 Tw (hipoperfundidos, con inestabilidad hemodinmica, en)Tj T* 0.0004 Tc -0.0578 Tw (sepsis grave y choque sptico; se podra evitar el uso de)Tj T* -0.0005 Tc -0.0627 Tw (ostomas en pacientes muy comprometidos, convirtin-)Tj T* 0.0001 Tc -0.0113 Tw (dose en una herramienta vlida de manejo. La mortali-)Tj T* 0.0003 Tc -0.0208 Tw (dad de 11,5% es baja comparada con la reportada en la)Tj T* 0.0001 Tc -0.0013 Tw (literatura y es independiente del manejo propuesto. En)Tj T* 0.0002 Tc 0.0440 Tw (estudios prospectivos y controlados se podr verificar)Tj T* 0.0003 Tc 0.0127 Tw (el verdadero valor de esta observacin.)Tj ET 0.000 G 0 J 0 j 0.51 w 10 M []0 d 1 i 85.825 465.345 m 587.575 465.345 l 85.825 94.095 m 587.575 94.095 l S BT /F4 1 Tf 12 0 0 12 147.325 421.95 Tm -0.0080 Tc -0.0625 Tw (Clinical evolution of severe peritonitis in critically ill patients that underwent)Tj 10.625 -1.2 TD -0.0147 Tc (deferred primary closure)Tj 3.375 -2.4 TD -0.0226 Tc 0.0000 Tw (Abstract)Tj /F2 1 Tf 11 0 0 11 85.825 350.76 Tm 0.0014 Tc (Introduction)Tj /F3 1 Tf 5.2418 0 TD 0.0023 Tc 0.1252 Tw [(. Primary anastomosis is a feasible tec)10.5(hnique in the mana)10.5(g)8.7(ement of se)15.9(ver)35(e)0( secondary peritonitis)]TJ -5.2418 -1.2 TD 0.0029 Tc 0.1250 Tw [(in critically ill pa)5.6(tients; howe)16(ver)106.5(,)4.7( its use has been limited due to the risk of complications and death.)]TJ /F2 1 Tf 0 -2.4 TD 0.0077 Tc 0.1248 Tw (Materials and methods)Tj /F3 1 Tf 9.8591 0 TD 0.0082 Tc 0.1249 Tw [(.)5.9( )40.8(W)91.2(e)-0.1( selected patients with se)16.4(ver)35.5(e)-0.4( secondary peritonitis that r)35.5(equir)40.9(ed r)38.2(esection of an)]TJ -9.8591 -1.2 TD 0.0002 Tc 0.0493 Tw [(intestinal se)41.1(gment and mana)11.1(g)9.3(ed with tempor)11.1(ary intestinal ligatur)35.7(e)7.8(,)2( open abdomen, elective r)38.4(e)-3.1(peat lapar)43.8(otomies,)]TJ T* 0.0004 Tc 0.1074 Tw [(and ulterior deferr)34.9(ed primary anastomosis. Primor)35.9(dial success was labeled in those patients that had primary)]TJ T* 0.0139 Tc 0.1255 Tw (anastomosis and no leakage or fistulae.)Tj /F2 1 Tf 0 -2.4 TD 0.0012 Tc 0.0000 Tw (Results)Tj /F3 1 Tf 3.0082 0 TD 0.0014 Tc 0.1254 Tw [(.)-6.2( )20.8(T)74.7(w)0.2(enty six patients wer)36.9(e)-1( included in the study)49.9(,)0.5( with a mean )20.8(AP)94.1(A)28.8(CHE II scor)34.1(e of 15.3. )12.6(Ther)39.6(e wer)39.6(e)-3.1( 6)]TJ -3.0082 -1.2 TD 0.0002 Tc 0.1181 Tw [(anastomoses in the small bowel, 5 in the lar)35.7(g)9.3(e)-0.3( bowel, 4 of the ileum to the lar)35.6(g)9.3(e)-0.3( bowel, and in 3 patients an)]TJ T* 0.0230 Tc 0.1251 Tw [(anastomosis could not be performed. )20.4(A mean of 4 sc)14.8(heduled r)36.6(elapar)47.5(otomies wer)36.6(e)-3( r)39.4(e)38.8(gister)39.4(ed, starting 24)]TJ T* 0.0202 Tc [(hour)6.6(s after the anastomosis. Primor)33.8(dial success was ac)9.3(hie)14.7(ved in 20 patients \(77%\), 28-day survival was)]TJ T* 0.0001 Tc 0.1055 Tw [(88.3%; 23 patients left the hospital alive)7.7(, and only 3 \(11.5%\) died in the ICU; these deaths wer)38.3(e)-0.1( independent)]TJ T* 0.0173 Tc 0.1250 Tw [(of the pr)44.6(ocedur)36.4(e)11.3(.)]TJ /F2 1 Tf 0 -2.4 TD 0.0129 Tc 0.0000 Tw (Discussion)Tj /F3 1 Tf 4.6309 0 TD 0.0133 Tc 0.1251 Tw [(. Dama)7.8(g)8.8(e)0.3( contr)48.8(ol sur)37.8(g)8.8(e)-4.6(ry was feasible and secur)35.1(e in patients with se)13.3(ver)43.3(e)-0.5( secondary peritonitis,)]TJ -4.6309 -1.2 TD 0.0064 Tc 0.1249 Tw [(with a primary success r)17.3(a)-3.6(te of 77%; f)20(istulae de)11.9(veloped in 11.5%, and mortality was 11.5%.)]TJ 0 -2.4 TD 0.0098 Tc 0.1255 Tw [(K)35.9(e)31.1(y wor)37.1(ds: peritonitis, clinical e)15.3(v)1.1(olution,)-6.6( mortality)56.2(, lapar)48(otomy)52.9(,)0.7( sutur)37.1(e tec)12.5(hniques.)]TJ ET endstream endobj 33 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 9 0 R /F2 10 0 R /F3 11 0 R /F4 12 0 R >> /ExtGState << /GS2 14 0 R >> >> endobj 35 0 obj << /Length 22766 >> stream BT /F1 1 Tf 10 0 0 10 577.585 60.3 Tm 0.000 g /GS2 gs -0.0010 Tc 0.0000 Tw (29)Tj 8 0 0 8 91.825 777.51 Tm 0.0143 Tc 0.1247 Tw [(CURSO CLNICO DE LA PERIT)18.1(ONITIS GRA)141.8(VE EN P)96.8(A)35.1(CIENTES CRTICAMENTE ENFERMOS )21.5(TRA)115.6(T)85.3(ADOS CON SUTURA PRIMARIA...)]TJ 9 0 0 9 85.825 701.7001 Tm 0.0000 Tc 0.0000 Tw [(1.)-823.3(M)]TJ 6.3 0 0 6.3 107.815 701.7001 Tm -0.0252 Tc (ASTBOOM)Tj 9 0 0 9 137.515 701.7001 Tm -0.0166 Tc -0.0867 Tw [( WJ, )-24.6(K)]TJ 6.3 0 0 6.3 160.525 701.7001 Tm -0.0259 Tc 0.0000 Tw (UYPERS)Tj 9 0 0 9 183.715 701.7001 Tm -0.0164 Tc -0.0640 Tw [( HH, S)]TJ 6.3 0 0 6.3 206.425 701.7001 Tm -0.0260 Tc 0.0000 Tw [(CHOO)35.9(TS)]TJ 9 0 0 9 230.425 701.7001 Tm -0.0167 Tc -0.0618 Tw [( FJ, )28.2(W)]TJ 6.3 0 0 6.3 251.935 701.7001 Tm -0.0260 Tc 0.0000 Tw (OBBES)Tj 9 0 0 9 271.435 701.7001 Tm -0.0169 Tc -0.0798 Tw [( T)70.8(.)-0.2( )-12.5(Small-bo)26.4(wel)]TJ -19.05 -1.2 TD 0.0130 Tc 0.1250 Tw (perforation complicating the open treatment of generalized)Tj T* 0.0000 Tc -0.0216 Tw (peritonitis. Arch Surg. 1989; 124:689-92.)Tj -1.5733 -1.8267 TD 0.0000 Tw [(2.)-823.3(S)]TJ 6.3 0 0 6.3 105.115 663.66 Tm 0.0243 Tc (CHEIN)Tj 9 0 0 9 125.125 663.66 Tm 0.0152 Tc 0.1254 Tw [( M, S)]TJ 6.3 0 0 6.3 147.835 663.66 Tm 0.0245 Tc 0.0000 Tw (AADIA)Tj 9 0 0 9 168.865 663.66 Tm 0.0166 Tc 0.1253 Tw [( R, F)]TJ 6.3 0 0 6.3 189.565 663.66 Tm 0.0237 Tc 0.0000 Tw (REINKEL)Tj 9 0 0 9 217.585 663.66 Tm 0.0166 Tc 0.1253 Tw [( Z, D)]TJ 6.3 0 0 6.3 239.335 663.66 Tm 0.0222 Tc 0.0000 Tw (ECKER)Tj 9 0 0 9 260.665 663.66 Tm 0.0169 Tc 0.1270 Tw [( GA. Aggressive)]TJ -17.8533 -1.2 TD 0.0001 Tc -0.0185 Tw [(treatment of se)30.1(v)16.8(e)0.4(re dif)26.8(fuse peritonitis: a prospecti)26.8(v)16.8(e)-0.1( study)66.8(.)0.5( Br J)]TJ T* -0.0036 Tc -0.0611 Tw (Surg. 1988; 75:173-6.)Tj -1.5733 -1.83 TD 0.0000 Tc 0.0000 Tw [(3.)-823.3(W)]TJ 6.3 0 0 6.3 108.475 625.59 Tm 0.0005 Tc (ITTMAN)Tj 9 0 0 9 132.985 625.59 Tm -0.0001 Tc 0.1056 Tw [( DH, A)]TJ 6.3 0 0 6.3 161.125 625.59 Tm 0.0000 Tw (PREHAMIAN)Tj 9 0 0 9 198.565 625.59 Tm -0.0004 Tc 0.1055 Tw [( C, B)]TJ 6.3 0 0 6.3 219.235 625.59 Tm 0.0000 Tc 0.0000 Tw (ERGSTEIN)Tj 9 0 0 9 249.685 625.59 Tm 0.0001 Tc 0.1039 Tw [( JM. Etappenlavage:)]TJ -16.6333 -1.2 TD 0.0195 Tc 0.1250 Tw (advanced diffuse peritonitis managed by planned multiple)Tj T* -0.0119 Tc -0.0626 Tw [(laparotomies utilizing zippers, slide f)11.4(astener)34.8(, and )48.2(V)110.1(elcro analogue)]TJ T* 0.0001 Tc 0.0062 Tw [(for temporary abdominal closure. )26.7(W)77.4(o)-0.2(rld J Sur)20.1(g. 1990; 14:218-)]TJ T* 0.0000 Tc 0.0000 Tw (26.)Tj -1.5733 -1.8267 TD [(4.)-823.3(P)]TJ 6.3 0 0 6.3 104.965 565.95 Tm 0.0008 Tc [(A)108.5(TIO)]TJ 9 0 0 9 123.865 565.95 Tm 0.0006 Tc 0.0932 Tw [( JF)77.3(, )5.8(Q)]TJ 6.3 0 0 6.3 146.575 565.95 Tm 0.0001 Tc 0.0000 Tw [(UINTER)38.2(O)]TJ 9 0 0 9 173.965 565.95 Tm 0.0000 Tc 0.0938 Tw [( G, B)]TJ 6.3 0 0 6.3 194.935 565.95 Tm 0.0000 Tw (APTISTE)Tj 9 0 0 9 220.135 565.95 Tm 0.0001 Tc 0.0872 Tw [( S. )-5.3(Infeccin )-7.3(quirr)16.8(gica. )-7.2(En:)]TJ -13.35 -1.2 TD -0.0052 Tc -0.0624 Tw [(P)17.5(a)2.1(tio JF)78.1(, editor)54.8(. Lecciones en ciruga. 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N Engl J Med. 2003; 348:138-50.)Tj -1.5733 -1.8267 TD 0.0000 Tw [(7.)-823.3(M)]TJ 6.3 0 0 6.3 107.965 473.4 Tm -0.0002 Tc (ARSHALL)Tj 9 0 0 9 137.035 473.4 Tm -0.0007 Tc -0.0296 Tw [( J, I)]TJ 6.3 0 0 6.3 149.725 473.4 Tm -0.0005 Tc 0.0000 Tw (NNES)Tj 9 0 0 9 166.165 473.4 Tm 0.0002 Tc -0.0296 Tw [( M. Intensive care unit management of intra-)]TJ -7.3533 -1.2 TD 0.0000 Tc -0.0324 Tw (abdominal infection. Crit Care Med. 200; 31:2228-37.)Tj -1.5733 -1.8267 TD 0.0000 Tw [(8.)-823.3(P)]TJ 6.3 0 0 6.3 104.965 446.16 Tm 0.0007 Tc [(A)56(UGAM)]TJ 9 0 0 9 128.425 446.16 Tm 0.0000 Tc (-B)Tj 6.3 0 0 6.3 137.425 446.16 Tm 0.0017 Tc [(UR)68.3(TZ)]TJ 9 0 0 9 153.475 446.16 Tm 0.0005 Tc -0.0537 Tw [( C, D)]TJ 6.3 0 0 6.3 171.775 446.16 Tm 0.0001 Tc 0.0000 Tw (UPONT)Tj 9 0 0 9 192.775 446.16 Tm 0.0009 Tc -0.0513 Tw [( H, )5.3(M)]TJ 6.3 0 0 6.3 213.085 446.16 Tm -0.0001 Tc 0.0000 Tw (ARMUSE)Tj 9 0 0 9 239.335 446.16 Tm 0.0001 Tc -0.0512 Tw [( JP)110.1(, C)]TJ 6.3 0 0 6.3 258.685 446.16 Tm -0.0002 Tc 0.0000 Tw [(HOSIDO)33.1(W)]TJ 9 0 0 9 288.235 446.16 Tm 0.0000 Tc -0.0553 Tw [( D, )-6.3(M)]TJ 6.3 0 0 6.3 308.515 446.16 Tm 0.0002 Tc 0.0000 Tw (ALEK)Tj 9 0 0 9 99.985 435.36 Tm -0.0003 Tc -0.0555 Tw (L, D)Tj 6.3 0 0 6.3 115.975 435.36 Tm -0.0001 Tc 0.0000 Tw (ESMONTS)Tj 9 0 0 9 145.375 435.36 Tm -0.0555 Tw [( JM, )]TJ /F3 1 Tf 1.9167 0 TD -0.0003 Tc (et al)Tj /F1 1 Tf 1.6933 0 TD 0.0001 Tc -0.0567 Tw (. Daily organ-system failure for diagnosis)Tj -8.6533 -1.2 TD 0.0454 Tc 0.1256 Tw (of persistent intra-abdominal sepsis after postoperative)Tj T* 0.0000 Tc 0.0167 Tw (peritonitis. Intensive Care Med. 2002; 28:594-8.)Tj -1.5733 -1.83 TD 0.0000 Tw [(9.)-823.3(R)]TJ 6.3 0 0 6.3 106.075 397.29 Tm 0.0160 Tc (ICHE)Tj 9 0 0 9 121.165 397.29 Tm 0.0122 Tc 0.1228 Tw [( FC, C)]TJ 6.3 0 0 6.3 147.775 397.29 Tm 0.0164 Tc 0.0000 Tw (HOLLEY)Tj 9 0 0 9 173.575 397.29 Tm 0.0113 Tc 0.1246 Tw [( BP)111.3(, P)]TJ 6.3 0 0 6.3 198.175 397.29 Tm 0.0160 Tc 0.0000 Tw (ANIS)Tj 9 0 0 9 213.325 397.29 Tm 0.0109 Tc 0.0391 Tw [( YH, )-82.3(L)]TJ 6.3 0 0 6.3 240.625 397.29 Tm 0.0164 Tc 0.0000 Tw (AISNE)Tj 9 0 0 9 259.675 397.29 Tm 0.0113 Tc 0.1237 Tw [( MJ, B)]TJ 6.3 0 0 6.3 286.765 397.29 Tm 0.0163 Tc 0.0000 Tw (RIARD)Tj 9 0 0 9 306.865 397.29 Tm 0.0114 Tc 0.1267 Tw [( CG,)]TJ -22.9867 -1.2 TD 0.0000 Tc 0.0000 Tw (G)Tj 6.3 0 0 6.3 106.465 386.49 Tm -0.0002 Tc (RAULET)Tj 9 0 0 9 131.335 386.49 Tm 0.0000 Tc -0.0444 Tw [( AM, )]TJ /F3 1 Tf 2.2667 0 TD -0.0500 Tw (et al)Tj /F1 1 Tf 1.7 0 TD 0.0001 Tc -0.0489 Tw (. Inflammatory cytokine response in patients)Tj -7.45 -1.2 TD -0.0015 Tc -0.0625 Tw (with septic shock secondary to generalized peritonitis. Crit Care)Tj T* 0.0000 Tc 0.0139 Tw (Med. 2000; 28\(2\):433-7.)Tj -1.5733 -1.8267 TD 0.0000 Tw [(10.)-323.3(B)]TJ 6.3 0 0 6.3 105.865 348.45 Tm -0.0191 Tc (ORREZ)Tj 9 0 0 9 130.315 348.45 Tm -0.0131 Tc -0.0611 Tw [( OA. Peritonitis terciaria. En: Quintero G, Nieto J, )6.4(Lerma)]TJ -3.37 -1.2 TD 0.0001 Tc -0.0417 Tw [(C., editor)56.8(. Infeccin en ciruga. Bogot: Editorial Mdica P)16.8(ana-)]TJ T* -0.0371 Tw (mericana; 2001. p. 238-44.)Tj -1.5733 -1.8267 TD 0.0000 Tc 0.0000 Tw [(11.)-323.3(B)]TJ 6.3 0 0 6.3 105.985 310.41 Tm -0.0048 Tc (ORREZ)Tj 9 0 0 9 131.035 310.41 Tm -0.0030 Tc -0.0623 Tw [( OA. Abdomen abierto. En: Quintero G, Nieto J, Lerma)]TJ -3.45 -1.2 TD 0.0001 Tc -0.0417 Tw [(C., editor)56.8(. Infeccin en ciruga. Bogot: Editorial Mdica P)16.8(ana-)]TJ T* -0.0371 Tw (mericana; 2001. p. 230-7.)Tj -1.5733 -1.83 TD 0.0000 Tc 0.0000 Tw [(12.)-323.3(N)]TJ 6.3 0 0 6.3 106.435 272.34 Tm -0.0082 Tc (IETO)Tj 9 0 0 9 120.535 272.34 Tm -0.0063 Tc -0.0618 Tw [( JA. Sepsis abdominal. Urgencias mdico-quirrgicas. Bo-)]TJ -2.2833 -1.2 TD 0.0000 Tc -0.0167 Tw (got: Editorial Distribuna; 2002. p. 189-98.)Tj -1.5733 -1.8267 TD 0.0000 Tw [(13.)-323.3(O)]TJ 6.3 0 0 6.3 106.465 245.1 Tm 0.0004 Tc (RDEZ)Tj 9 0 0 9 132.025 245.1 Tm -0.0003 Tc 0.0750 Tw [( CA, F)]TJ 6.3 0 0 6.3 157.615 245.1 Tm 0.0000 Tc 0.0000 Tw (RANCO)Tj 9 0 0 9 179.665 245.1 Tm 0.0755 Tw [( JE. Peritonitis y sepsis intraabdominal.)]TJ -8.8533 -1.2 TD 0.0850 Tw (En: editores? Cuidado intensivo y trauma. Bogot: Editorial)Tj T* 0.0278 Tw (Distribuna; 2003. p. 667-84.)Tj -1.5733 -1.8267 TD 0.0000 Tw [(14.)-323.3(U)]TJ 6.3 0 0 6.3 106.315 207.06 Tm -0.0181 Tc (RIBE)Tj 9 0 0 9 120.175 207.06 Tm -0.0138 Tc -0.0626 Tw [( R. Sepsis abdominal. Tpicos en Medicina Intensiva. 2003;)]TJ -2.2433 -1.2 TD -0.0031 Tc 0.0000 Tw (2:195-203.)Tj -1.5733 -1.83 TD 0.0000 Tc [(15.)-323.3(B)]TJ 6.3 0 0 6.3 106.015 179.79 Tm 0.0084 Tc (ULGER)Tj 9 0 0 9 127.225 179.79 Tm 0.0053 Tc 0.1256 Tw [( EM, M)]TJ 6.3 0 0 6.3 158.035 179.79 Tm 0.0000 Tc 0.0000 Tw (C)Tj 9 0 0 9 162.265 179.79 Tm (M)Tj 6.3 0 0 6.3 170.335 179.79 Tm 0.0088 Tc (AHON)Tj 9 0 0 9 188.665 179.79 Tm 0.0053 Tc 0.1256 Tw [( K, J)]TJ 6.3 0 0 6.3 207.925 179.79 Tm 0.0067 Tc 0.0000 Tw (URKOVICH)Tj 9 0 0 9 241.525 179.79 Tm 0.0056 Tc 0.1261 Tw [( GJ. The morbidity of)]TJ -15.7267 -1.2 TD 0.0001 Tc -0.0124 Tw [(penetrating colon injury)66.8(.)1( Injury)66.8(.)0( 2003; 34:41-6.)]TJ -1.5733 -1.8267 TD 0.0000 Tc 0.0000 Tw [(16.)-323.3(C)]TJ 6.3 0 0 6.3 106.015 152.55 Tm 0.0095 Tc (URRAN)Tj 9 0 0 9 128.365 152.55 Tm 0.0056 Tc 0.1111 Tw [( TJ, )-23(B)]TJ 6.3 0 0 6.3 152.635 152.55 Tm 0.0130 Tc 0.0000 Tw [(R)46.7(OZO)46.3(T)100.2(A)]TJ 9 0 0 9 177.415 152.55 Tm 0.0070 Tc 0.1271 Tw [( )54.1(A. Complications of primary repair of)]TJ -8.6033 -1.2 TD 0.0001 Tc -0.0434 Tw (colon injury: literature review of 2,964 cases. Am J Surg. 1999;)Tj T* -0.0035 Tc 0.0000 Tw (177:42-7.)Tj -1.5733 -1.8267 TD 0.0000 Tc [(17.)-323.3(G)]TJ 6.3 0 0 6.3 106.465 114.51 Tm -0.0001 Tc (ONZLEZ)Tj 9 0 0 9 135.535 114.51 Tm -0.0002 Tc -0.0391 Tw [( RP)113.1(, F)]TJ 6.3 0 0 6.3 156.565 114.51 Tm 0.0001 Tc 0.0000 Tw (ALIMIRSKI)Tj 9 0 0 9 189.115 114.51 Tm 0.0008 Tc -0.0398 Tw [( ME, H)]TJ 6.3 0 0 6.3 215.185 114.51 Tm 0.0006 Tc 0.0000 Tw [(OLEV)138.7(AR)]TJ 9 0 0 9 239.875 114.51 Tm 0.0000 Tc -0.0390 Tw [( MR. Further e)26.7(v)26.7(aluation)]TJ -15.5433 -1.2 TD -0.0109 Tc -0.0623 Tw [(of colostomy in penetrating colon injury)59.1(.)0.1( )55.8(Am Sur)15.8(g. 2000; 66:342-)]TJ T* 0.0000 Tc 0.0000 Tw (6.)Tj 27.5667 67.6433 TD [(18.)-320(N)]TJ 6.3 0 0 6.3 368.725 701.7001 Tm 0.0003 Tc (ESPOLI)Tj 9 0 0 9 390.085 701.7001 Tm 0.0007 Tc -0.0407 Tw [( A, )-63(R)]TJ 6.3 0 0 6.3 409.165 701.7001 Tm 0.0003 Tc 0.0000 Tw [(A)131.8(VIZZINI)]TJ 9 0 0 9 435.985 701.7001 Tm -0.0003 Tc 0.0176 Tw [( C, )17.3(T)]TJ 6.3 0 0 6.3 454.375 701.7001 Tm -0.0001 Tc 0.0000 Tw (RIVELLA)Tj 9 0 0 9 481.315 701.7001 Tm -0.0002 Tc 0.0195 Tw [( M, S)]TJ 6.3 0 0 6.3 501.415 701.7001 Tm 0.0006 Tc 0.0000 Tw (EGALA)Tj 9 0 0 9 522.775 701.7001 Tm 0.0003 Tc 0.0192 Tw [( M. )16.2(The choice of)]TJ -17.84 -1.2 TD 0.0027 Tc 0.1254 Tw (surgical procedure for peritonitis due to colonic perforation.)Tj T* -0.0002 Tc -0.0629 Tw (Arch Surg. 1993; 128:814-8.)Tj -1.57 -1.8267 TD 0.0000 Tc 0.0000 Tw [(19.)-320(R)]TJ 6.3 0 0 6.3 368.215 663.66 Tm -0.1315 Tc [(AV)-90.5(O)]TJ 9 0 0 9 380.785 663.66 Tm -0.0017 Tc 0.1237 Tw [( B, M)]TJ 6.3 0 0 6.3 403.735 663.66 Tm -0.0002 Tc 0.0000 Tw [(ETW)118.8(ALL)104.5(Y)]TJ 9 0 0 9 432.775 663.66 Tm 0.0000 Tc 0.1221 Tw [( N, C)]TJ 6.3 0 0 6.3 454.225 663.66 Tm 0.0003 Tc 0.0000 Tw (ASTERA)Tj 9 0 0 9 478.735 663.66 Tm -0.1100 Tc 0.2307 Tw [( P,)-110( P)]TJ 6.3 0 0 6.3 496.675 663.66 Tm -0.0001 Tc 0.0000 Tw (OLANSKY)Tj 9 0 0 9 526.765 663.66 Tm 0.1217 Tw [( PJ, G)]TJ 6.3 0 0 6.3 550.735 663.66 Tm -0.0018 Tc 0.0000 Tw (ER)Tj 9 0 0 9 558.775 663.66 Tm 0.0005 Tc 0.1221 Tw [( R. )19.3(The)]TJ -21.84 -1.2 TD 0.0266 Tc 0.1250 Tw (importance of intraluminal anastomotic fecal contact and)Tj T* 0.0007 Tc (peritonitis in colonic anastomotic leakages. An experimental)Tj T* 0.0000 Tc 0.0133 Tw [(study)66.7(.)0( Dis Colon Rectum. 1988; 31:868-71.)]TJ -1.57 -1.83 TD 0.0000 Tw [(20.)-320(S)]TJ 6.3 0 0 6.3 367.165 614.79 Tm -0.0098 Tc (CHILLING)Tj 9 0 0 9 396.415 614.79 Tm -0.0061 Tc -0.0614 Tw [( MK, M)]TJ 6.3 0 0 6.3 424.165 614.79 Tm -0.0601 Tc 0.0000 Tw [(AU)-52(R)-52.1(E)-52(R)]TJ 9 0 0 9 444.865 614.79 Tm -0.0071 Tc -0.0627 Tw [( CA, K)]TJ 6.3 0 0 6.3 469.135 614.79 Tm -0.0092 Tc 0.0000 Tw (OLLMAR)Tj 9 0 0 9 495.385 614.79 Tm -0.0067 Tc -0.0628 Tw [( O, B)]TJ 6.3 0 0 6.3 513.175 614.79 Tm -0.0095 Tc 0.0000 Tw (UCHLER)Tj 9 0 0 9 538.015 614.79 Tm -0.0069 Tc -0.0622 Tw [( MW)93.1(. )5.4(Primary)]TJ /F3 1 Tf -19.5333 -1.2 TD 0.0000 Tc 0.0000 Tw (Vs)Tj /F1 1 Tf 1 0 TD 0.0001 Tc 0.1246 Tw (. secondary anastomoses after sigmoid colon resection for)Tj -1 -1.2 TD -0.0111 Tc -0.0625 Tw (perforated diverticulitis \(Hinchey Stage III and IV\): a prospective)Tj T* 0.0000 Tc 0.0604 Tw (outcome and cost analysis. Dis Colon Rectum. 2001; 44:699-)Tj T* 0.0000 Tw (703.)Tj -1.57 -1.8267 TD [(21.)-320(E)]TJ 6.3 0 0 6.3 367.735 555.15 Tm -0.0001 Tc [(D)31.4(W)120.1(ARDS)]TJ 9 0 0 9 394.075 555.15 Tm -0.0011 Tc -0.0123 Tw [( DP)108.9(, L)]TJ 6.3 0 0 6.3 416.575 555.15 Tm -0.0005 Tc 0.0000 Tw [(EPPINGT)13.8(ON)]TJ 9 0 0 9 451.465 555.15 Tm 0.0000 Tc (-C)Tj 6.3 0 0 6.3 460.465 555.15 Tm 0.0001 Tc (LARKE)Tj 9 0 0 9 481.465 555.15 Tm -0.0010 Tc -0.0690 Tw [( A, )-57.3(S)]TJ 6.3 0 0 6.3 498.985 555.15 Tm -0.0008 Tc 0.0000 Tw [(EXT)13.5(ON)]TJ 9 0 0 9 520.225 555.15 Tm -0.0129 Tw [( R, H)]TJ 6.3 0 0 6.3 539.215 555.15 Tm 0.0002 Tc 0.0000 Tw (EALD)Tj 9 0 0 9 556.015 555.15 Tm -0.0003 Tc -0.0133 Tw [( RJ, M)]TJ 6.3 0 0 6.3 580.015 555.15 Tm 0.0000 Tc 0.0000 Tw (O)Tj 9 0 0 9 584.575 555.15 Tm (-)Tj 6.3 0 0 6.3 362.215 544.35 Tm -0.0008 Tc (RAN)Tj 9 0 0 9 375.535 544.35 Tm 0.0000 Tc 0.1199 Tw [( BJ. Stoma-related complications are more frequent after)]TJ -1.48 -1.2 TD 0.0332 Tc 0.1250 Tw (transverse colostomy than loop ileostomy: a prospective)Tj T* -0.0001 Tc -0.0630 Tw [(randomized clinical trial. )-5.3(Br J Surg. 2001; 88:360-3.)]TJ -1.57 -1.8267 TD 0.0000 Tc 0.0000 Tw [(22.)-320(B)]TJ 6.3 0 0 6.3 368.215 506.31 Tm 0.0007 Tc (IONDO)Tj 9 0 0 9 388.525 506.31 Tm 0.0000 Tc -0.0291 Tw [( S, J)]TJ 6.3 0 0 6.3 403.285 506.31 Tm -0.0003 Tc 0.0000 Tw [(A)55(URRIET)94.9(A)]TJ 9 0 0 9 434.185 506.31 Tm 0.0002 Tc -0.0287 Tw [( E, J)]TJ 6.3 0 0 6.3 449.425 506.31 Tm 0.0006 Tc 0.0000 Tw [(ORB)33.9(A)]TJ 9 0 0 9 466.735 506.31 Tm -0.0014 Tc -0.0286 Tw [( R, M)]TJ 6.3 0 0 6.3 486.925 506.31 Tm -0.0003 Tc 0.0000 Tw (ORENO)Tj 9 0 0 9 508.615 506.31 Tm -0.1100 Tc 0.0807 Tw [( P,)-110( F)]TJ 6.3 0 0 6.3 523.885 506.31 Tm 0.0000 Tc 0.0000 Tw (ARRAN)Tj 9 0 0 9 545.935 506.31 Tm 0.0002 Tc -0.0277 Tw [( L, B)]TJ 6.3 0 0 6.3 563.665 506.31 Tm 0.0000 Tw [(OR)38.3(OBIA)]TJ 9 0 0 9 362.215 495.51 Tm -0.0760 Tc [(F,)-76( )]TJ /F3 1 Tf 0.9567 0 TD -0.0003 Tc -0.0222 Tw (et al)Tj /F1 1 Tf 1.7267 0 TD 0.0001 Tc [(. Intraoperati)30.1(v)16.8(e colonic la)20.1(v)30.1(a)-2.6(ge and primary anastomoses)]TJ -2.6833 -1.2 TD 0.0000 Tc -0.0035 Tw (in peritonitis and obstruction. Br J Surg. 1997; 84:222-5.)Tj -1.57 -1.83 TD 0.0000 Tw [(23.)-320(B)]TJ 6.3 0 0 6.3 368.215 468.24 Tm 0.0007 Tc (IONDO)Tj 9 0 0 9 388.525 468.24 Tm 0.0000 Tc 0.0607 Tw [( S, )-6.6(P)]TJ 6.3 0 0 6.3 406.435 468.24 Tm -0.0005 Tc 0.0000 Tw (EREA)Tj 9 0 0 9 422.875 468.24 Tm -0.0009 Tc 0.0649 Tw [( MT)69.1(, R)]TJ 6.3 0 0 6.3 449.635 468.24 Tm 0.0011 Tc 0.0000 Tw [(A)42.2(GUE)]TJ 9 0 0 9 466.885 468.24 Tm -0.0014 Tc 0.0665 Tw [( JM, P)]TJ 6.3 0 0 6.3 491.275 468.24 Tm 0.0004 Tc 0.0000 Tw (ARES)Tj 9 0 0 9 507.385 468.24 Tm 0.0000 Tc 0.0613 Tw [( D, )-6.4(J)]TJ 6.3 0 0 6.3 525.265 468.24 Tm -0.0003 Tc 0.0000 Tw [(A)55(URRIET)90.2(A)]TJ 9 0 0 9 556.165 468.24 Tm 0.0002 Tc 0.0644 Tw [( E. One-)]TJ -21.55 -1.2 TD 0.0001 Tc -0.0222 Tw (stage procedure in non-elective surgery for diverticular disease)Tj T* 0.0000 Tc -0.0347 Tw (complications. Colorectal Dis. 2001; 3:42-5.)Tj -1.57 -1.8267 TD 0.0000 Tw [(24.)-320(Z)]TJ 6.3 0 0 6.3 367.735 430.2 Tm -0.0003 Tc (ORCOLO)Tj 9 0 0 9 393.625 430.2 Tm -0.0501 Tw [( L, C)]TJ 6.3 0 0 6.3 410.965 430.2 Tm -0.0434 Tc 0.0000 Tw [(OVO)-7.1(T)-45.2(T)56.6(A)]TJ 9 0 0 9 435.475 430.2 Tm -0.0003 Tc -0.0501 Tw [( L, C)]TJ 6.3 0 0 6.3 452.815 430.2 Tm 0.0002 Tc 0.0000 Tw [(ARLOMA)38.3(GNO)]TJ 9 0 0 9 493.525 430.2 Tm 0.0000 Tc -0.0495 Tw [( N, B)]TJ 6.3 0 0 6.3 511.885 430.2 Tm 0.0012 Tc 0.0000 Tw [(AR)67.9(T)17(OLO)]TJ 9 0 0 9 536.935 430.2 Tm -0.0001 Tc -0.0496 Tw [( DC. Safety of)]TJ -19.4133 -1.2 TD -0.0166 Tc -0.0621 Tw [(primary anastomoses in emer)13.4(genc)20.1(y colo-rectal sur)16.7(gery)66.7(. Colorectal)]TJ T* 0.0000 Tc -0.0139 Tw (Dis. 2003; 5:262-9.)Tj -1.57 -1.8267 TD 0.0000 Tw [(25.)-320(C)]TJ 6.3 0 0 6.3 368.215 392.16 Tm -0.0001 Tc (HAPPUIS)Tj 9 0 0 9 394.465 392.16 Tm 0.0009 Tc -0.0571 Tw [( CW)94.2(, )6.5(F)]TJ 6.3 0 0 6.3 418.825 392.16 Tm 0.0000 Tc 0.0000 Tw (REY)Tj 9 0 0 9 431.425 392.16 Tm 0.0005 Tc -0.0567 Tw [( DJ, )5.8(D)]TJ 6.3 0 0 6.3 453.625 392.16 Tm 0.0002 Tc 0.0000 Tw (IETZEN)Tj 9 0 0 9 475.675 392.16 Tm 0.0003 Tc -0.0572 Tw [( CD, )5.8(P)]TJ 6.3 0 0 6.3 498.865 392.16 Tm -0.0002 Tc 0.0000 Tw [(ANETT)90.3(A)]TJ 9 0 0 9 523.465 392.16 Tm -0.0698 Tw [( TP)113.1(, )-9.7(B)]TJ 6.3 0 0 6.3 544.525 392.16 Tm -0.0003 Tc 0.0000 Tw (UECHTER)Tj 9 0 0 9 573.565 392.16 Tm 0.0010 Tc -0.0572 Tw [( KJ,)]TJ -23.4833 -1.2 TD 0.0000 Tc 0.0000 Tw (C)Tj 6.3 0 0 6.3 368.485 381.36 Tm 0.0360 Tc (OHN)Tj 9 0 0 9 382.825 381.36 Tm 0.0258 Tc 0.1241 Tw [( I, J)]TJ 6.3 0 0 6.3 399.475 381.36 Tm 0.0000 Tc 0.0000 Tw (R)Tj 9 0 0 9 403.915 381.36 Tm 0.0263 Tc 0.1266 Tw [(. )5.5(Management of penetrating colon injuries. A)]TJ -4.6333 -1.2 TD 0.0000 Tc -0.0185 Tw (prospective randomized trial. Ann Surg. 1991; 213:492-7.)Tj -1.57 -1.83 TD 0.0000 Tw [(26.)-320(D)]TJ 6.3 0 0 6.3 368.725 354.09 Tm (EMETRIADES)Tj 9 0 0 9 408.625 354.09 Tm 0.0513 Tw [( D, )7(M)]TJ 6.3 0 0 6.3 430.735 354.09 Tm -0.0006 Tc 0.0000 Tw [(URRA)104.1(Y)]TJ 9 0 0 9 452.125 354.09 Tm 0.0000 Tc 0.0510 Tw [( J)63.3(A)-1.3(, )8(C)]TJ 6.3 0 0 6.3 475.165 354.09 Tm 0.0003 Tc 0.0000 Tw (HAN)Tj 9 0 0 9 488.815 354.09 Tm 0.0020 Tc 0.0445 Tw [( L, O)]TJ 6.3 0 0 6.3 508.435 354.09 Tm 0.0004 Tc 0.0000 Tw (RDEZ)Tj 9 0 0 9 533.965 354.09 Tm 0.0006 Tc 0.0480 Tw [( C, )5.6(B)]TJ 6.3 0 0 6.3 553.585 354.09 Tm 0.0008 Tc 0.0000 Tw [(O)32.3(WLEY)]TJ 9 0 0 9 576.115 354.09 Tm 0.0000 Tc 0.0513 Tw [( D,)]TJ -23.7667 -1.2 TD 0.0000 Tw (N)Tj 6.3 0 0 6.3 368.725 343.29 Tm 0.0003 Tc (AGY)Tj 9 0 0 9 382.375 343.29 Tm 0.0007 Tc 0.0022 Tw ( KK, )Tj /F3 1 Tf 2.2 0 TD 0.0000 Tc 0.0000 Tw (et al)Tj /F1 1 Tf 1.75 0 TD 0.0001 Tc 0.0033 Tw (. Penetrating colon injuries requiring resection:)Tj -6.19 -1.2 TD 0.0217 Tc 0.1250 Tw (diversion or primary anastomoses? An AAST prospective)Tj T* 0.0001 Tc 0.0177 Tw [(multicenter study)66.8(.)-0.6( J )16.7(T)31.1(r)-0.2(auma. 2001; 50:765-75.)]TJ -1.57 -1.8267 TD 0.0000 Tc 0.0000 Tw [(27.)-320(G)]TJ 6.3 0 0 6.3 369.025 305.25 Tm 0.0436 Tc (ONZLEZ)Tj 9 0 0 9 400.015 305.25 Tm 0.0315 Tc 0.1226 Tw [( RP)114.8(, M)]TJ 6.3 0 0 6.3 428.665 305.25 Tm 0.0448 Tc 0.0000 Tw [(ERLO)44.8(TTI)]TJ 9 0 0 9 456.625 305.25 Tm 0.0306 Tc 0.1228 Tw [( GJ, )-7.9(H)]TJ 6.3 0 0 6.3 483.775 305.25 Tm 0.0447 Tc 0.0000 Tw [(OLEV)130.4(A)5.2(R)]TJ 9 0 0 9 510.175 305.25 Tm 0.0312 Tc 0.1220 Tw [( MR. )-5.7(Colostomy )-6(in)]TJ -16.44 -1.2 TD -0.0112 Tc -0.0624 Tw (penetrating colon injury: is it necessary? J Trauma. 1996; 41:271-)Tj T* 0.0000 Tc 0.0000 Tw (5.)Tj -1.57 -1.8267 TD [(28.)-320(M)]TJ 6.3 0 0 6.3 370.225 267.21 Tm -0.0022 Tc [(URRA)112.1(Y)]TJ 9 0 0 9 391.525 267.21 Tm -0.0641 Tc 0.0003 Tw [( JA)-65.4(,)-57.4( D)]TJ 6.3 0 0 6.3 413.035 267.21 Tm -0.0037 Tc 0.0000 Tw (EMETRIADES)Tj 9 0 0 9 452.725 267.21 Tm -0.0067 Tc -0.0561 Tw [( D,)-6.7( C)]TJ 6.3 0 0 6.3 470.725 267.21 Tm -0.0023 Tc 0.0000 Tw (OLSON)Tj 9 0 0 9 491.635 267.21 Tm 0.0000 Tc -0.0625 Tw [( M,)6.7( S)]TJ 6.3 0 0 6.3 510.235 267.21 Tm -0.0044 Tc 0.0000 Tw (ONG)Tj 9 0 0 9 523.765 267.21 Tm -0.0030 Tc -0.0620 Tw [( Z, )45(V)]TJ 6.3 0 0 6.3 540.865 267.21 Tm -0.0039 Tc 0.0000 Tw (ELMAHOS)Tj 9 0 0 9 571.165 267.21 Tm -0.0011 Tc -0.0624 Tw [( GC,)]TJ -23.2167 -1.2 TD 0.0000 Tc 0.0000 Tw (C)Tj 6.3 0 0 6.3 368.215 256.41 Tm 0.0004 Tc (ORNWELL)Tj 9 0 0 9 399.025 256.41 Tm 0.0002 Tc -0.0332 Tw [( EE, III )]TJ /F3 1 Tf 3.1233 0 TD 0.0000 Tc -0.0333 Tw (et al)Tj /F1 1 Tf 1.7167 0 TD (. Colonic resection in trauma: colostomy)Tj /F3 1 Tf -8.93 -1.2 TD 0.0003 Tc 0.0000 Tw (versus)Tj /F1 1 Tf 2.5567 0 TD 0.0000 Tc 0.0167 Tw [( anastomoses. J Trauma. 1999; 46:250-4.)]TJ -4.1267 -1.83 TD 0.0000 Tw [(29.)-320(N)]TJ 6.3 0 0 6.3 368.725 229.14 Tm 0.0004 Tc (ELSON)Tj 9 0 0 9 389.035 229.14 Tm -0.0009 Tc -0.0297 Tw [( R, S)]TJ 6.3 0 0 6.3 406.225 229.14 Tm 0.0005 Tc 0.0000 Tw (INGER)Tj 9 0 0 9 425.485 229.14 Tm 0.0001 Tc -0.0303 Tw [( M. Primary repair for penetrating colon inju-)]TJ -7.03 -1.2 TD -0.0075 Tw [(ries. Cochrane Database Syst Re)26.8(v)66.8(.)0.2( 2002; \(3\):CD002247.)]TJ -1.57 -1.8267 TD 0.0000 Tc 0.0000 Tw [(30.)-320(S)]TJ 6.3 0 0 6.3 367.165 201.9 Tm -0.0102 Tc (ASAKI)Tj 9 0 0 9 386.065 201.9 Tm -0.0073 Tc -0.0604 Tw [( LS, )55.6(A)]TJ 6.3 0 0 6.3 407.875 201.9 Tm -0.0098 Tc 0.0000 Tw (LLABEN)Tj 9 0 0 9 432.325 201.9 Tm -0.0080 Tc -0.0615 Tw [( RD, G)]TJ 6.3 0 0 6.3 456.565 201.9 Tm -0.0121 Tc 0.0000 Tw [(OL)68.8(W)112.9(ALA)]TJ 9 0 0 9 482.275 201.9 Tm -0.0080 Tc -0.0587 Tw [( R, M)]TJ 6.3 0 0 6.3 501.625 201.9 Tm -0.0102 Tc 0.0000 Tw [(ITT)94.5(AL)]TJ 9 0 0 9 518.935 201.9 Tm -0.0068 Tc -0.1165 Tw [( VK. )-54.4(Primary )-51.8(r)6.5(e)-2.8(pair)]TJ -17.4133 -1.2 TD 0.0000 Tc 0.1156 Tw [(of colon injuries: a prospecti)26.7(v)16.7(e)-0.5( randomized study)66.7(.)-1.3( J )17(T)34.3(r)-0.3(auma.)]TJ T* -0.0556 Tw (1995; 39:895-901.)Tj -1.57 -1.8267 TD 0.0000 Tw [(31.)-320(S)]TJ 6.3 0 0 6.3 367.225 163.86 Tm 0.0005 Tc (INGER)Tj 9 0 0 9 386.485 163.86 Tm 0.0004 Tc 0.1074 Tw [( MA, N)]TJ 6.3 0 0 6.3 416.185 163.86 Tm 0.0005 Tc 0.0000 Tw (ELSON)Tj 9 0 0 9 436.465 163.86 Tm 0.0001 Tc 0.1085 Tw [( RL. Primary repair of penetrating colon)]TJ -8.25 -1.2 TD -0.0055 Tc -0.0624 Tw [(injuries: a systematic re)28.5(vie)24.5(w)66.5(.)-0.1( Dis Colon Rectum. 2002; 45:1579-)]TJ T* 0.0000 Tc 0.0000 Tw (87.)Tj -1.57 -1.83 TD [(32.)-320(A)]TJ 6.3 0 0 6.3 368.875 125.79 Tm 0.0255 Tc (DKINS)Tj 9 0 0 9 388.915 125.79 Tm 0.0167 Tc 0.1250 Tw [( AL, R)]TJ 6.3 0 0 6.3 416.815 125.79 Tm 0.0256 Tc 0.0000 Tw (OBBINS)Tj 9 0 0 9 440.875 125.79 Tm 0.0181 Tc 0.1250 Tw [( J, V)]TJ 6.3 0 0 6.3 460.675 125.79 Tm 0.0237 Tc 0.0000 Tw (ILLALBA)Tj 9 0 0 9 488.725 125.79 Tm 0.0170 Tc 0.1250 Tw [( M, )]TJ /F3 1 Tf 1.9567 0 TD 0.0178 Tc 0.1222 Tw (et al)Tj /F1 1 Tf 1.96 0 TD 0.0176 Tc 0.1278 Tw (. Open abdomen)Tj -17.9733 -1.2 TD -0.0046 Tc -0.0627 Tw (management of intra-abdominal sepsis. Am Surg. 2004; 70:137-)Tj T* 0.0000 Tc 0.0000 Tw (40.)Tj /F4 1 Tf 12 0 0 12 304.825 731.04 Tm 0.0006 Tc 0.0583 Tw [( Referencias)]TJ ET endstream endobj 36 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 9 0 R /F3 11 0 R /F4 12 0 R >> /ExtGState << /GS2 14 0 R >> >> endobj 38 0 obj << /Length 20392 >> stream BT /F1 1 Tf 10 0 0 10 85.825 60.3 Tm 0.000 g /GS2 gs -0.0010 Tc 0.0000 Tw (30)Tj 8 0 0 8 85.825 777.4501 Tm 0.0066 Tc 0.1251 Tw [(ORDEZ C., PINED)36.6(A J.)7.8(, )55.4(ARIAS R., BENTEZ F)81.6(.)0.3(, )25.5(TOR)36.6(O L.,)6.6( )55.4(ARISTIZB)40.4(AL G., MAR)62.9(TNEZ J., ROSSO F)81.6(.)0.3(, GRAN)36.6(ADOS M., BADIEL M.)]TJ 9 0 0 9 85.825 733.4401 Tm 0.0000 Tc 0.0000 Tw [(33.)-323.3(A)]TJ 6.3 0 0 6.3 106.465 733.4401 Tm 0.0003 Tc (PRAHAMIAN)Tj 9 0 0 9 144.625 733.4401 Tm 0.0002 Tc 0.0057 Tw [( C, )29.2(W)]TJ 6.3 0 0 6.3 165.715 733.4401 Tm 0.0005 Tc 0.0000 Tw (ITTMAN)Tj 9 0 0 9 190.225 733.4401 Tm 0.0012 Tc 0.0043 Tw ( D, B)Tj 6.3 0 0 6.3 209.575 733.4401 Tm -0.0003 Tc 0.0000 Tw (ERSTEIN)Tj 9 0 0 9 235.465 733.4401 Tm 0.0004 Tc 0.0046 Tw [( JM. )16.1(T)71.4(emporary abdomi-)]TJ -15.0533 -1.2 TD 0.0001 Tc -0.0198 Tw [(nal closure \(T)96.8(A)38.8(C\) for planned relaparotomy \(etappenla)23.4(v)26.8(a)0.8(ge\) in)]TJ T* -0.0209 Tw [(trauma. J Trauma. 1990; 30:719-23.)]TJ -1.5733 -1.8267 TD 0.0000 Tc 0.0000 Tw [(34.)-323.3(B)]TJ 6.3 0 0 6.3 105.985 695.4 Tm -0.0004 Tc (OSSCHA)Tj 9 0 0 9 130.825 695.4 Tm -0.0002 Tc -0.0549 Tw [( K, H)]TJ 6.3 0 0 6.3 149.575 695.4 Tm 0.0000 Tc 0.0000 Tw [(ULST)95.2(AER)61.9(T)]TJ 9 0 0 9 180.775 695.4 Tm -0.0002 Tc -0.0548 Tw [( PF)79.8(, )45(V)]TJ 6.3 0 0 6.3 201.925 695.4 Tm 0.0002 Tc 0.0000 Tw (ISSER)Tj 9 0 0 9 219.085 695.4 Tm -0.0003 Tc -0.0548 Tw [( MR, )]TJ /F3 1 Tf 2.1933 0 TD -0.0555 Tw (et al)Tj /F1 1 Tf 1.6933 0 TD 0.0001 Tc -0.0554 Tw (. Open management)Tj -17.12 -1.2 TD 0.1229 Tw (of the abdomen and planned reoperations in severe bacterial)Tj T* 0.0000 Tc -0.0167 Tw (peritonitis. Eur J Surg. 2000; 166:44-9.)Tj -1.5733 -1.8267 TD 0.0000 Tw [(35.)-323.3(H)]TJ 6.3 0 0 6.3 107.035 657.36 Tm 0.0304 Tc (AU)Tj 9 0 0 9 116.815 657.36 Tm -0.0110 Tc 0.1866 Tw [( T,)-71( O)]TJ 6.3 0 0 6.3 139.735 657.36 Tm 0.0855 Tc 0.0000 Tw (HMANN)Tj 9 0 0 9 166.225 657.36 Tm 0.0621 Tc 0.1255 Tw [( C,)5.4( )34.3(W)]TJ 6.3 0 0 6.3 192.175 657.36 Tm 0.0848 Tc 0.0000 Tw [(OLMERSHA)51.4(USER)]TJ 9 0 0 9 249.025 657.36 Tm 0.0613 Tc 0.1287 Tw [( A,)8( )]TJ /F3 1 Tf 1.9667 0 TD 0.0597 Tc 0.1278 Tw (et al)Tj /F1 1 Tf 2.1767 0 TD 0.0604 Tc (. Planned)Tj -20.7033 -1.2 TD 0.0002 Tc 0.0000 Tw (relaparotomy )Tj /F3 1 Tf 5.62 0 TD 0.0000 Tc (Vs)Tj /F1 1 Tf 1 0 TD 0.0001 Tc 0.0436 Tw (. relaparotomy on demand in the treatment of)Tj -6.62 -1.2 TD 0.0000 Tc 0.0135 Tw (intra-abdominal infections. The Peritonitis Study Group of the)Tj T* -0.0005 Tc -0.0620 Tw (Surgical Infection Society-Europe. Arch Surg. 1995; 130:1193-)Tj T* 0.0000 Tc 0.0000 Tw (7.)Tj -1.5733 -1.83 TD [(36.)-323.3(H)]TJ 6.3 0 0 6.3 106.675 597.6901 Tm 0.0326 Tc (OLZHEIMER)Tj 9 0 0 9 144.925 597.6901 Tm 0.0246 Tc 0.1272 Tw [( RG,)4.6( )7.1(G)]TJ 6.3 0 0 6.3 174.175 597.6901 Tm 0.0344 Tc 0.0000 Tw [(A)113.5(THOF)]TJ 9 0 0 9 195.535 597.6901 Tm 0.0233 Tc 0.1260 Tw [( B. Re-operation for complicated)]TJ -10.6167 -1.2 TD 0.0188 Tc 0.1253 Tw (secondary peritonitis - how to identify patients at risk for)Tj T* 0.0000 Tc 0.0437 Tw (persistent sepsis. Eur J Med Res. 2003; 27:125-34.)Tj -1.5733 -1.8267 TD 0.0000 Tw [(37.)-323.3(K)]TJ 6.3 0 0 6.3 106.465 559.65 Tm -0.0005 Tc [(OPERN)28(A)]TJ 9 0 0 9 131.485 559.65 Tm -0.0710 Tc 0.1577 Tw [( T,)-71( )-14(S)]TJ 6.3 0 0 6.3 149.785 559.65 Tm 0.0001 Tc 0.0000 Tw (CHULZ)Tj 9 0 0 9 170.785 559.65 Tm 0.1043 Tw [( F)76.8(.)-2.4( Relaparotomy in peritonitis: prognosis)]TJ -7.8667 -1.2 TD 0.0346 Tc 0.1250 Tw (and treatment of patients with persisting intraabdominal)Tj T* -0.0001 Tc -0.0477 Tw [(infection. )26.6(W)77.2(o)-0.4(rld J Sur)16.6(g. 2000; 24:32-7.)]TJ -1.5733 -1.8267 TD 0.0000 Tc 0.0000 Tw [(38.)-323.3(L)]TJ 6.3 0 0 6.3 105.415 521.61 Tm -0.0053 Tc (AMME)Tj 9 0 0 9 124.885 521.61 Tm -0.0046 Tc -0.0611 Tw [( B, B)]TJ 6.3 0 0 6.3 142.315 521.61 Tm -0.0052 Tc 0.0000 Tw (OERMEESTER)Tj 9 0 0 9 183.265 521.61 Tm -0.0045 Tc -0.0611 Tw [( MA, R)]TJ 6.3 0 0 6.3 209.185 521.61 Tm 0.0000 Tw (EITSMA)Tj 9 0 0 9 232.435 521.61 Tm -0.0043 Tc -0.0611 Tw [( JB, )]TJ /F3 1 Tf 1.66 0 TD -0.0039 Tc (et al)Tj /F1 1 Tf 1.6667 0 TD -0.0042 Tc -0.0639 Tw (. Meta-analysis of)Tj -18.0433 -1.2 TD -0.0115 Tc -0.0625 Tw (relaparotomy for secondary peritonitis. Br J Surg. 2002; 89:1516-)Tj T* 0.0000 Tc 0.0000 Tw (24.)Tj -1.5733 -1.83 TD [(39.)-323.3(M)]TJ 6.3 0 0 6.3 107.965 483.54 Tm (C)Tj 9 0 0 9 112.165 483.54 Tm (P)Tj 6.3 0 0 6.3 117.175 483.54 Tm -0.0001 Tc (ARTLAND)Tj 9 0 0 9 147.265 483.54 Tm -0.0002 Tc 0.0056 Tw [( KJ, H)]TJ 6.3 0 0 6.3 170.635 483.54 Tm 0.0007 Tc 0.0000 Tw (YMAN)Tj 9 0 0 9 189.865 483.54 Tm 0.0000 Tc 0.0072 Tw [( NH. Damage control: what is its role)]TJ -9.9867 -1.2 TD -0.0357 Tw (in colorectal surgery? Dis Colon Rectum. 2003; 46:981-6.)Tj -1.5733 -1.8267 TD 0.0000 Tw [(40.)-323.3(P)]TJ 6.3 0 0 6.3 105.475 456.3 Tm 0.0793 Tc (ENNINCKX)Tj 9 0 0 9 142.375 456.3 Tm 0.0537 Tc 0.1235 Tw [( FM, )-7.5(K)]TJ 6.3 0 0 6.3 173.815 456.3 Tm 0.0793 Tc 0.0000 Tw (ERREMANS)Tj 9 0 0 9 212.125 456.3 Tm 0.0555 Tc 0.1253 Tw [( RP)112.2(, L)]TJ 6.3 0 0 6.3 239.635 456.3 Tm 0.0798 Tc 0.0000 Tw [(A)63.7(UWERS)]TJ 9 0 0 9 268.825 456.3 Tm 0.0557 Tc 0.1253 Tw [( PM. Planned)]TJ -18.76 -1.2 TD 0.0001 Tc 0.0572 Tw (relaparotomies in the surgical treatment of severe generalized)Tj T* -0.0001 Tc -0.0296 Tw [(peritonitis from intestinal origin. )26.8(W)77.2(o)-0.4(rld J Sur)16.6(g. 1983; 7:762-6.)]TJ -1.5733 -1.8267 TD 0.0000 Tc 0.0000 Tw [(41.)-323.3(R)]TJ 6.3 0 0 6.3 105.985 418.26 Tm 0.0008 Tc [(O)41.8(T)16.6(ONDO)]TJ 9 0 0 9 132.235 418.26 Tm -0.0001 Tc -0.0290 Tw [( M, S)]TJ 6.3 0 0 6.3 151.465 418.26 Tm 0.0007 Tc 0.0000 Tw [(CHW)119.7(AB)]TJ 9 0 0 9 174.175 418.26 Tm -0.0014 Tc -0.0289 Tw [( CW)91.9(, M)]TJ 6.3 0 0 6.3 202.015 418.26 Tm 0.0000 Tc 0.0000 Tw (C)Tj 9 0 0 9 206.215 418.26 Tm (G)Tj 6.3 0 0 6.3 212.725 418.26 Tm 0.0003 Tc (ONIGAL)Tj 9 0 0 9 236.875 418.26 Tm -0.0001 Tc -0.0288 Tw [( M, )]TJ /F3 1 Tf 1.5833 0 TD 0.0003 Tc -0.0278 Tw (et al)Tj /F1 1 Tf 1.7233 0 TD -0.0001 Tc -0.0302 Tw [(. Damage Con-)]TJ -18.5167 -1.2 TD 0.0001 Tc 0.1127 Tw (trol: An approach for improved survival in exsanguinations)Tj T* 0.0000 Tc -0.0223 Tw [(penetrating abdominal injury)66.7(.)0.4( J )16.6(T)34.3(r)-0.3(auma. 1993; 35:375.)]TJ -1.5733 -1.83 TD 0.0000 Tw [(42.)-323.3(R)]TJ 6.3 0 0 6.3 106.075 380.19 Tm 0.0135 Tc [(O)45(T)15(ONDO)]TJ 9 0 0 9 132.775 380.19 Tm 0.0103 Tc 0.1231 Tw [( MF)83.6(, Z)]TJ 6.3 0 0 6.3 160.075 380.19 Tm 0.0139 Tc 0.0000 Tw (OMIES)Tj 9 0 0 9 180.085 380.19 Tm 0.0095 Tc 0.1261 Tw [( D)6.2(.)-0.5( )12.3(The damage control sequence and)]TJ -8.9 -1.2 TD 0.0000 Tc -0.0595 Tw (underlying logic. Surg Clin North Am. 2005; 77:761-77.)Tj -1.5733 -1.8267 TD 0.0000 Tw [(43.)-323.3(S)]TJ 6.3 0 0 6.3 104.935 352.95 Tm -0.0054 Tc (CHEIN)Tj 9 0 0 9 123.985 352.95 Tm -0.0045 Tc -0.0616 Tw [( M. Surgical management of intra-abdominal infection: is)]TJ -2.6667 -1.2 TD -0.0010 Tc -0.0627 Tw (there any evidence? Langenbecks Arch Surg. 2002; 387:1-7.)Tj -1.5733 -1.8267 TD 0.0000 Tc 0.0000 Tw [(44.)-323.3(S)]TJ 6.3 0 0 6.3 104.965 325.71 Tm -0.0003 Tc (CHREIBER)Tj 9 0 0 9 136.135 325.71 Tm -0.0001 Tc 0.0582 Tw [( M. Damage Control Sur)13.2(gery)66.6(. Crit Care Clin. 2005;)]TJ -4.0167 -1.2 TD -0.0031 Tc 0.0000 Tw (20:101-18.)Tj -1.5733 -1.83 TD 0.0000 Tc [(45.)-323.3(S)]TJ 6.3 0 0 6.3 104.965 298.44 Tm 0.0010 Tc [(CHW)120(AR)62.9(TZ)]TJ 9 0 0 9 134.965 298.44 Tm -0.0010 Tc -0.0857 Tw [( A, )-48(O)]TJ 6.3 0 0 6.3 153.565 298.44 Tm -0.0339 Tc 0.0000 Tw [(NAC)-35.4(A)]TJ 9 0 0 9 170.965 298.44 Tm 0.0000 Tc -0.0320 Tw [( N, )8.3(R)]TJ 6.3 0 0 6.3 189.565 298.44 Tm 0.0009 Tc 0.0000 Tw (ABI)Tj 9 0 0 9 200.425 298.44 Tm 0.0000 Tc -0.0330 Tw [( I, )]TJ /F3 1 Tf 1.01 0 TD -0.0333 Tw (et al)Tj /F1 1 Tf 1.7167 0 TD 0.0001 Tc -0.0364 Tw (. Closure of the abdomen by)Tj -13.8867 -1.2 TD 0.0002 Tc 0.0380 Tw [(mesh for planned re-laparotomy)66.9(.)5( )56.8(A technical modif)23.5(ication. Int)]TJ T* -0.0038 Tc -0.0611 Tw (Surg. 1997; 82:42-3.)Tj -1.5733 -1.8267 TD 0.0000 Tc 0.0000 Tw [(46.)-323.3(S)]TJ 6.3 0 0 6.3 104.965 260.4 Tm -0.0003 Tc (UGRUE)Tj 9 0 0 9 126.685 260.4 Tm 0.0000 Tc -0.0255 Tw [( M. Abdominal compartment syndrome. Curr Opin Crit)]TJ -2.9667 -1.2 TD -0.0555 Tw (Care. 2005; 11:333-8.)Tj -1.5733 -1.8267 TD 0.0000 Tw [(47.)-323.3(B)]TJ 6.3 0 0 6.3 105.925 233.16 Tm -0.0085 Tc (URCH)Tj 9 0 0 9 123.175 233.16 Tm -0.0067 Tc -0.0591 Tw [( J, F)]TJ 6.3 0 0 6.3 137.065 233.16 Tm -0.0088 Tc 0.0000 Tw (RANCIOSE)Tj 9 0 0 9 168.115 233.16 Tm -0.0047 Tc -0.0620 Tw [( R, M)]TJ 6.3 0 0 6.3 187.525 233.16 Tm -0.0105 Tc 0.0000 Tw (OORE)Tj 9 0 0 9 204.415 233.16 Tm -0.0057 Tc -0.0626 Tw [( E, B)]TJ 6.3 0 0 6.3 221.275 233.16 Tm -0.0107 Tc 0.0000 Tw (IFFL)Tj 9 0 0 9 233.965 233.16 Tm -0.1007 Tc 0.0074 Tw [( W,)-97.4( )-28(O)]TJ 6.3 0 0 6.3 253.285 233.16 Tm -0.0102 Tc 0.0000 Tw (FFNER)Tj 9 0 0 9 272.575 233.16 Tm -0.0062 Tc -0.0598 Tw [( P)110.5(.)0.5( )7.4(Single-layer)]TJ -19.1767 -1.2 TD -0.0006 Tc 0.0000 Tw (continuous)Tj /F3 1 Tf 4.3833 0 TD -0.0018 Tc -0.0611 Tw [( versus)]TJ /F1 1 Tf 2.7333 0 TD -0.0010 Tc -0.0625 Tw [( two-layer interrupted intestinal anastomoses:)]TJ -7.1167 -1.2 TD 0.0001 Tc -0.0199 Tw (a prospective randomized trial. Ann Surg. 2000; 231:832-7.)Tj -1.5733 -1.83 TD 0.0000 Tc 0.0000 Tw (48.)Tj 6.3 0 0 6.3 99.985 195.09 Tm 0.0003 Tc (DE)Tj 9 0 0 9 108.385 195.09 Tm -0.0553 Tc ( G)Tj 6.3 0 0 6.3 116.635 195.09 Tm -0.0001 Tc (RAAF)Tj 9 0 0 9 133.435 195.09 Tm 0.0003 Tc -0.0531 Tw [( JS, )]TJ 6.3 0 0 6.3 147.715 195.09 Tm -0.1315 Tc 0.0000 Tw [(VA)-130.3(N)]TJ 9 0 0 9 160.525 195.09 Tm -0.0553 Tc ( G)Tj 6.3 0 0 6.3 168.775 195.09 Tm -0.0007 Tc (OOR)Tj 9 0 0 9 182.065 195.09 Tm -0.0004 Tc -0.0521 Tw [( H, B)]TJ 6.3 0 0 6.3 200.365 195.09 Tm 0.0002 Tc 0.0000 Tw [(LEICHR)38.3(ODT)]TJ 9 0 0 9 235.825 195.09 Tm 0.0001 Tc -0.0555 Tw [( RP)110.1(. Primary small bo)30.1(wel)]TJ -15.0933 -1.2 TD -0.0063 Tc -0.0625 Tw (anastomosis in generalizad peritonitis. Eur J Surg. 1996; 162:55-)Tj T* 0.0000 Tc 0.0000 Tw (8.)Tj 27.5667 62.2167 TD [(49.)-320(M)]TJ 6.3 0 0 6.3 370.285 733.4401 Tm 0.0029 Tc (ORIURA)Tj 9 0 0 9 394.585 733.4401 Tm 0.0017 Tc 0.1259 Tw [( S, K)]TJ 6.3 0 0 6.3 415.165 733.4401 Tm 0.0043 Tc 0.0000 Tw [(OB)32.8(A)97.7(Y)116.8(ASHI)]TJ 9 0 0 9 446.365 733.4401 Tm 0.0021 Tc 0.1261 Tw [( I, I)]TJ 6.3 0 0 6.3 461.485 733.4401 Tm 0.0051 Tc 0.0000 Tw [(SHIGUR)38.4(O)]TJ 9 0 0 9 489.415 733.4401 Tm 0.0000 Tc 0.1340 Tw [( S,)-6.7( )30.7(T)]TJ 6.3 0 0 6.3 508.915 733.4401 Tm 0.0015 Tc 0.0000 Tw [(AB)25.3(A)114(T)88.7(A)]TJ 9 0 0 9 529.225 733.4401 Tm -0.0677 Tc 0.1844 Tw [( T,)-67.7( )76.7(Y)]TJ 6.3 0 0 6.3 548.785 733.4401 Tm 0.0041 Tc 0.0000 Tw (OSHIOKA)Tj 9 0 0 9 577.315 733.4401 Tm -0.1220 Tc 0.1620 Tw [( Y,)]TJ -23.9 -1.2 TD 0.0000 Tc 0.0000 Tw (M)Tj 6.3 0 0 6.3 370.225 722.64 Tm 0.0024 Tc [(A)105.4(TSUMO)45.2(T)18.2(O)]TJ 9 0 0 9 404.335 722.64 Tm 0.0022 Tc 0.1265 Tw [( )25.4(T)73.2(.)0.5( Continuous mattress suture for all hand-se)25.5(w)0.9(n)]TJ -4.68 -1.2 TD 0.0084 Tc 0.1250 Tw (anastomoses of the gastrointestinal tract. Am J Surg. 2002;)Tj T* -0.0031 Tc 0.0000 Tw (184:446-8.)Tj -1.57 -1.8267 TD 0.0000 Tc [(50.)-320(R)]TJ 6.3 0 0 6.3 368.215 684.6 Tm 0.0001 Tc (OTSTEIN)Tj 9 0 0 9 394.465 684.6 Tm 0.0000 Tc -0.0167 Tw [( OD, P)]TJ 6.3 0 0 6.3 418.915 684.6 Tm 0.0005 Tc 0.0000 Tw (RUETT)Tj 9 0 0 9 439.225 684.6 Tm -0.0003 Tc -0.0166 Tw [( TL, S)]TJ 6.3 0 0 6.3 461.665 684.6 Tm 0.0000 Tw (IMMONS)Tj 9 0 0 9 487.585 684.6 Tm 0.0001 Tc -0.0187 Tw [( RL. Microbiologic features)]TJ -13.93 -1.2 TD -0.0014 Tc -0.0623 Tw (and treatment of persistent peritonitis in patients in the intensive)Tj T* 0.0000 Tc -0.0416 Tw (care unit. Can J Surg. 1986; 29:247-50.)Tj -1.57 -1.8267 TD 0.0000 Tw [(51.)-320(S)]TJ 6.3 0 0 6.3 367.225 646.5601 Tm 0.0005 Tc (OLOMKIN)Tj 9 0 0 9 396.985 646.5601 Tm 0.0009 Tc 0.0377 Tw [( J, Y)]TJ 6.3 0 0 6.3 414.415 646.5601 Tm 0.0006 Tc 0.0000 Tw (ELLIN)Tj 9 0 0 9 432.625 646.5601 Tm -0.0011 Tc 0.0377 Tw [( A, R)]TJ 6.3 0 0 6.3 452.515 646.5601 Tm 0.0001 Tc 0.0000 Tw (OTSTEIN)Tj 9 0 0 9 478.765 646.5601 Tm 0.0006 Tc 0.0376 Tw [( O, C)]TJ 6.3 0 0 6.3 498.715 646.5601 Tm 0.0001 Tc 0.0000 Tw (HRISTOU)Tj 9 0 0 9 526.015 646.5601 Tm -0.0007 Tc 0.0377 Tw [( N, D)]TJ 6.3 0 0 6.3 546.415 646.5601 Tm 0.0004 Tc 0.0000 Tw (ELLINGER)Tj 9 0 0 9 577.225 646.5601 Tm 0.0007 Tc 0.0376 Tw [( E,)]TJ -23.89 -1.2 TD 0.0000 Tc 0.0000 Tw (T)Tj 6.3 0 0 6.3 367.765 635.76 Tm 0.0078 Tc (ELLADO)Tj 9 0 0 9 393.265 635.76 Tm 0.0050 Tc 0.1293 Tw [( J, )6.6(M)]TJ 6.3 0 0 6.3 414.025 635.76 Tm 0.0081 Tc 0.0000 Tw [(ALAF)70(AIA)]TJ 9 0 0 9 441.565 635.76 Tm 0.0050 Tc 0.1297 Tw [( O, )7.4(F)]TJ 6.3 0 0 6.3 462.325 635.76 Tm 0.0078 Tc 0.0000 Tw (ERNNDEZ)Tj 9 0 0 9 496.675 635.76 Tm 0.0057 Tc 0.0710 Tw [( A, )-49.6(C)]TJ 6.3 0 0 6.3 517.915 635.76 Tm 0.0082 Tc 0.0000 Tw (HOE)Tj 9 0 0 9 531.025 635.76 Tm 0.0065 Tc 0.1251 Tw [( K, )5.3(C)]TJ 6.3 0 0 6.3 552.775 635.76 Tm 0.0083 Tc 0.0000 Tw (ARIDES)Tj 9 0 0 9 575.815 635.76 Tm 0.0047 Tc 0.0753 Tw [( A,)]TJ -23.7333 -1.2 TD 0.0000 Tc 0.0000 Tw (S)Tj 6.3 0 0 6.3 367.225 624.96 Tm 0.0002 Tc [(A)112.7(TISHCHANDRAN)]TJ 9 0 0 9 420.775 624.96 Tm -0.1287 Tc 0.0854 Tw [( V,)-128.7( )-33.3(T)]TJ 6.3 0 0 6.3 437.875 624.96 Tm -0.0005 Tc 0.0000 Tw (EPPLER)Tj 9 0 0 9 460.615 624.96 Tm 0.0001 Tc 0.0081 Tw [( H. The Protocol 017 Study Group.)]TJ -10.9333 -1.2 TD 0.0003 Tc 0.0000 Tw (Ertapenem )Tj /F3 1 Tf 4.69 0 TD (versus)Tj /F1 1 Tf 2.5567 0 TD 0.0000 Tc 0.1089 Tw [( piperacillin/tazobactam in the treatment of)]TJ -7.2467 -1.2 TD -0.0078 Tc -0.0621 Tw (complicated intraabdominal infections: results of a double-blind,)Tj T* -0.0160 Tc -0.0625 Tw [(randomized comparative phase III trial. Ann Surg. 2003; 237:235-)]TJ T* 0.0000 Tc 0.0000 Tw (45.)Tj -1.57 -1.83 TD [(52.)-320(V)]TJ 6.3 0 0 6.3 368.665 565.29 Tm -0.0081 Tc (ISSER)Tj 9 0 0 9 385.585 565.29 Tm -0.0051 Tc -0.0621 Tw [( MR, B)]TJ 6.3 0 0 6.3 410.935 565.29 Tm -0.0081 Tc 0.0000 Tw (OSSCHA)Tj 9 0 0 9 435.475 565.29 Tm -0.0067 Tc -0.0620 Tw [( K, O)]TJ 6.3 0 0 6.3 453.835 565.29 Tm -0.0083 Tc 0.0000 Tw (LSMAN)Tj 9 0 0 9 475.615 565.29 Tm -0.0050 Tc -0.0620 Tw [( J, )]TJ /F3 1 Tf 0.9967 0 TD -0.0056 Tc -0.0611 Tw (et al)Tj /F1 1 Tf 1.66 0 TD -0.0054 Tc -0.0630 Tw (. Predictors of recurrence)Tj -15.2567 -1.2 TD 0.0299 Tc 0.1250 Tw [(of fulminant bacterial peritonitis after discontinuation of)]TJ T* 0.0001 Tc 0.0938 Tw (antibiotics in open management of the abdomen. Eur J Surg.)Tj T* 0.0000 Tc -0.0556 Tw (1998; 164:825-9.)Tj -1.57 -1.8267 TD 0.0000 Tw [(53.)-320(B)]TJ 6.3 0 0 6.3 368.215 516.45 Tm 0.0007 Tc (IONDO)Tj 9 0 0 9 388.525 516.45 Tm 0.0000 Tc -0.0291 Tw [( S, J)]TJ 6.3 0 0 6.3 403.285 516.45 Tm -0.0003 Tc 0.0000 Tw [(A)55(URRIET)94.9(A)]TJ 9 0 0 9 434.185 516.45 Tm 0.0002 Tc -0.0287 Tw [( E, J)]TJ 6.3 0 0 6.3 449.425 516.45 Tm 0.0006 Tc 0.0000 Tw [(ORB)33.9(A)]TJ 9 0 0 9 466.735 516.45 Tm -0.0014 Tc -0.0286 Tw [( R, M)]TJ 6.3 0 0 6.3 486.925 516.45 Tm -0.0003 Tc 0.0000 Tw (ORENO)Tj 9 0 0 9 508.615 516.45 Tm -0.1100 Tc 0.0807 Tw [( P,)-110( F)]TJ 6.3 0 0 6.3 523.885 516.45 Tm 0.0000 Tc 0.0000 Tw (ARRAN)Tj 9 0 0 9 545.935 516.45 Tm 0.0002 Tc -0.0277 Tw [( L, B)]TJ 6.3 0 0 6.3 563.665 516.45 Tm 0.0000 Tw [(OR)38.3(OBIA)]TJ 9 0 0 9 362.215 505.65 Tm -0.0927 Tc 0.0157 Tw [(F,)-69.4( B)]TJ 6.3 0 0 6.3 375.775 505.65 Tm -0.0251 Tc 0.0000 Tw [(ETT)22.5(ONICA)]TJ 9 0 0 9 405.835 505.65 Tm -0.0211 Tc -0.0592 Tw [( C, P)]TJ 6.3 0 0 6.3 421.585 505.65 Tm -0.0278 Tc 0.0000 Tw [(O)46.6(VES)]TJ 9 0 0 9 437.065 505.65 Tm -0.0177 Tc -0.0647 Tw [( I, R)]TJ 6.3 0 0 6.3 450.865 505.65 Tm -0.0265 Tc 0.0000 Tw (AMOS)Tj 9 0 0 9 468.415 505.65 Tm -0.0221 Tc -0.0613 Tw [( E, )49.9(A)]TJ 6.3 0 0 6.3 484.675 505.65 Tm -0.0271 Tc 0.0000 Tw [(LCOBEND)39.6(AS)]TJ 9 0 0 9 520.675 505.65 Tm -0.0192 Tc -0.0622 Tw [( F)80.8(.)-2.5( Role of r)-5.9(esection)]TJ -17.6067 -1.2 TD 0.0001 Tc 0.1094 Tw (and primary anastomosis of the left colon in the presence of)Tj T* 0.0000 Tc -0.0111 Tw (peritonitis. Br J Surg. 2000; 87:1580-4.)Tj -1.57 -1.8267 TD 0.0000 Tw [(54.)-320(C)]TJ 6.3 0 0 6.3 368.215 467.61 Tm -0.0035 Tc [(HRIST)15.5(OU)]TJ 9 0 0 9 395.275 467.61 Tm -0.0013 Tc -0.0612 Tw [( NV)132(, B)]TJ 6.3 0 0 6.3 418.615 467.61 Tm -0.0031 Tc 0.0000 Tw (ARIE)Tj 9 0 0 9 433.225 467.61 Tm -0.0016 Tc -0.0638 Tw [( PS, D)]TJ 6.3 0 0 6.3 455.215 467.61 Tm -0.0031 Tc 0.0000 Tw (ELLINGER)Tj 9 0 0 9 485.875 467.61 Tm -0.0012 Tc -0.0635 Tw [( EP)115.5(, )28.6(W)]TJ 6.3 0 0 6.3 509.125 467.61 Tm -0.0046 Tc 0.0000 Tw [(A)98.3(YMA)43(C)-6(K)]TJ 9 0 0 9 536.065 467.61 Tm -0.0015 Tc -0.0641 Tw [( JP)111.8(, S)]TJ 6.3 0 0 6.3 554.065 467.61 Tm -0.0037 Tc 0.0000 Tw [(T)12.1(ONE)]TJ 9 0 0 9 570.685 467.61 Tm -0.0017 Tc -0.0623 Tw [( HH.)]TJ -23.1633 -1.2 TD 0.0172 Tc 0.1256 Tw [(Sur)17.2(gical infection Society intra-abdominal infection study)67.2(.)]TJ T* -0.0047 Tc -0.0620 Tw (Prospective evaluation of management techniques and outcome.)Tj T* -0.0002 Tc -0.0629 Tw (Arch Surg. 1993; 128:193-9.)Tj -1.57 -1.83 TD 0.0000 Tc 0.0000 Tw [(55.)-320(W)]TJ 6.3 0 0 6.3 370.615 418.74 Tm -0.0160 Tc (ITTMANN)Tj 9 0 0 9 398.965 418.74 Tm -0.0115 Tc -0.0624 Tw [( D. Newer methods of operative therapy for peritonitis:)]TJ -4.0833 -1.2 TD -0.0132 Tc -0.0627 Tw (Open abdomen, planned relaparotomy or staged abdominal repair)Tj T* 0.0000 Tc 0.0120 Tw [(\(ST)93.3(AR\). In: )15.3(T)74.3(ellado J, Christou N. Intra-abdominal Infections.)]TJ T* 0.0416 Tw (Madrid: Hartcourt; 2000. p. 153-177.)Tj -1.57 -1.8267 TD 0.0000 Tw [(56.)-320(R)]TJ 6.3 0 0 6.3 368.215 369.9 Tm 0.0004 Tc (IVERS)Tj 9 0 0 9 386.425 369.9 Tm 0.0001 Tc -0.0549 Tw [( E, N)]TJ 6.3 0 0 6.3 404.185 369.9 Tm 0.0002 Tc 0.0000 Tw (GUYEN)Tj 9 0 0 9 426.235 369.9 Tm 0.0000 Tc -0.0528 Tw [( B, H)]TJ 6.3 0 0 6.3 444.535 369.9 Tm -0.0001 Tc 0.0000 Tw [(A)136.2(VST)95.1(AD)]TJ 9 0 0 9 468.625 369.9 Tm 0.0000 Tc -0.0560 Tw [( S, )]TJ /F3 1 Tf 1.2 0 TD -0.0003 Tc -0.0555 Tw (et al)Tj /F1 1 Tf 1.6933 0 TD 0.0001 Tc -0.0557 Tw [(. Early goal-direct therap)10.1(y)]TJ -14.7167 -1.2 TD -0.0570 Tw (in the treatment of severe sepsis and septic shock. N Eng J Med.)Tj T* 0.0000 Tc -0.0556 Tw (2001; 345:1368-77.)Tj -1.57 -1.8267 TD 0.0000 Tw [(57.)-320(S)]TJ 6.3 0 0 6.3 367.165 331.86 Tm -0.0036 Tc [(HAPIR)34.5(O)]TJ 9 0 0 9 390.235 331.86 Tm -0.0026 Tc -0.0621 Tw [( M, J)]TJ 6.3 0 0 6.3 407.275 331.86 Tm -0.0046 Tc 0.0000 Tw (ENKINS)Tj 9 0 0 9 430.225 331.86 Tm 0.0000 Tc -0.0653 Tw [( D,)6.7( )7.4(S)]TJ 6.3 0 0 6.3 447.175 331.86 Tm -0.0046 Tc 0.0000 Tw [(CHW)119.2(A)-6.1(B)]TJ 9 0 0 9 469.735 331.86 Tm -0.1007 Tc 0.0107 Tw [( W,)-100.7( )-23(R)]TJ 6.3 0 0 6.3 488.665 331.86 Tm -0.0055 Tc 0.0000 Tw [(O)40.3(T)10.3(ONDO)]TJ 9 0 0 9 514.765 331.86 Tm -0.0030 Tc -0.0627 Tw [( M. Damage control:)]TJ -16.95 -1.2 TD 0.0001 Tc -0.0179 Tw [(Collecti)26.8(v)16.8(e re)27.4(vie)26.8(w)68.8(.)1.2( J )16.6(T)31.1(r)-0.2(auma. 2000; 49:969-78.)]TJ -1.57 -1.83 TD 0.0000 Tc 0.0000 Tw [(58.)-320(J)]TJ 6.3 0 0 6.3 365.725 304.59 Tm -0.0027 Tc (OHNSON)Tj 9 0 0 9 391.885 304.59 Tm -0.0067 Tc -0.0571 Tw [( J,)-6.7( G)]TJ 6.3 0 0 6.3 407.365 304.59 Tm -0.0010 Tc 0.0000 Tw [(RA)37.1(CIAS)]TJ 9 0 0 9 430.165 304.59 Tm -0.1253 Tc 0.0086 Tw [( V,)-125.3( )-54(S)]TJ 6.3 0 0 6.3 445.615 304.59 Tm 0.0007 Tc 0.0000 Tw [(CHW)124.5(AB)]TJ 9 0 0 9 468.265 304.59 Tm -0.1007 Tc 0.0140 Tw [( W,)-100.7( )-19.7(R)]TJ 6.3 0 0 6.3 487.165 304.59 Tm -0.0030 Tc 0.0000 Tw [(EILL)97(Y)]TJ 9 0 0 9 504.685 304.59 Tm -0.0023 Tc -0.0622 Tw [( P)114.4(.)-2.3( Ev)17.7(olution in damage)]TJ -15.83 -1.2 TD -0.0027 Tc -0.0629 Tw [(contr)-6(ol for e)14(xsanguinating penetrating abdominal injury)64(.)-0.4( J )20.4(T)38.3(r)-3(au-)]TJ T* 0.0000 Tc -0.0555 Tw (ma. 2001; 51:261-71.)Tj ET q 1 i 18.000 18.000 637.450 821.700 re W n 0.000 G 0 J 0 j 0.51 w 1000 M []0 d 348.330 253.395 238.990 -79.990 re S Q BT 11 0 0 11 353.665 228.15 Tm -0.0066 Tc 0.0000 Tw (Correspondencia:)Tj T* 0.0000 Tc (C)Tj 7.7 0 0 7.7 361.015 214.95 Tm 0.0006 Tc (ARLOS)Tj 11 0 0 11 386.275 214.95 Tm -0.0782 Tc ( A)Tj 7.7 0 0 7.7 396.115 214.95 Tm 0.0012 Tc [(LBER)59.6(T)20(O)]TJ 11 0 0 11 425.485 214.95 Tm -0.0229 Tc ( O)Tj 7.7 0 0 7.7 435.925 214.95 Tm -0.0006 Tc (RDEZ)Tj 11 0 0 11 467.125 214.95 Tm -0.0229 Tc ( D)Tj 7.7 0 0 7.7 477.565 214.95 Tm -0.0015 Tc (ELGADO)Tj 11 0 0 11 509.185 214.95 Tm -0.0003 Tc -0.0211 Tw (, MD)Tj -14.1382 -1.2 TD -0.0053 Tc -0.0614 Tw (Correo electrnico: carlosordonez@telecom.com.co)Tj T* -0.0195 Tc -0.0636 Tw (Cali, Colombia)Tj ET endstream endobj 39 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 9 0 R /F3 11 0 R >> /ExtGState << /GS2 14 0 R >> >> endobj 13 0 obj << /Type /XObject /Subtype /Image /Width 1742 /Height 1037 /BitsPerComponent 1 /ImageMask true /Length 4884 /Filter /CCITTFaxDecode /DecodeParms << /K -1 /Columns 1742>> >> stream ,Ҡsmfs$ (,`^Y/`fZ h@YЬ A4ye,`*ye`,e&,4 ,`J<*(3<(<( <,?@`K,,5