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O'Marra et al: Perioperative management of septic peritonitis in small animals: A review
Veterinary Surgery 1, 2026

Perioperative management of septic peritonitis in small animals: A review

🔍 Key Findings

  • Early enteral nutrition (<24–48 hrs) is associated with improved survival and reduced hospitalization in dogs with septic peritonitis.
  • Appropriate empirical antimicrobials improve survival in cats, but data are mixed in dogs.
  • Recurrent septic peritonitis (RecSP) has poor survival (0%–43.9%); most common cause is gastrointestinal dehiscence.
  • Intraoperative hypotension and preoperative hypoalbuminemia may increase dehiscence risk, though findings are inconsistent.
  • Lidocaine CRI during surgery improves survival over opioids alone in dogs.
  • Hydroxyethyl starch (HES) is not recommended due to risks of coagulopathy and kidney injury; albumin use is controversial.
  • Intra-abdominal hypertension (IAH) is under-recognized but contributes to mortality; IAP monitoring should be considered.
  • Diagnostic tests (effusion lactate, glucose, cytology) are unreliable for detecting RecSP; clinical judgment and ultrasound are advised.

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← Articles

O'Marra et al: Perioperative management of septic peritonitis in small animals: A review
Veterinary Surgery 1, 2026

🔍 Key Findings

  • Early enteral nutrition (<24–48 hrs) is associated with improved survival and reduced hospitalization in dogs with septic peritonitis.
  • Appropriate empirical antimicrobials improve survival in cats, but data are mixed in dogs.
  • Recurrent septic peritonitis (RecSP) has poor survival (0%–43.9%); most common cause is gastrointestinal dehiscence.
  • Intraoperative hypotension and preoperative hypoalbuminemia may increase dehiscence risk, though findings are inconsistent.
  • Lidocaine CRI during surgery improves survival over opioids alone in dogs.
  • Hydroxyethyl starch (HES) is not recommended due to risks of coagulopathy and kidney injury; albumin use is controversial.
  • Intra-abdominal hypertension (IAH) is under-recognized but contributes to mortality; IAP monitoring should be considered.
  • Diagnostic tests (effusion lactate, glucose, cytology) are unreliable for detecting RecSP; clinical judgment and ultrasound are advised.

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Multiple Choice Questions on this study

In O'Marra 2026 et al., on perioperative septic peritonitis, which analgesic protocol was associated with increased short-term survival in dogs?

A. Opioids alone
B. NSAIDs alone
C. Lidocaine CRI alone
D. Opioid combined with lidocaine CRI
E. Alpha-2 agonist CRI

Answer: Opioid combined with lidocaine CRI

Explanation: Multimodal intraoperative analgesia using opioids and lidocaine CRI resulted in improved short-term survival over opioids alone in dogs with septic peritonitis.
In O'Marra 2026 et al., on perioperative septic peritonitis, which diagnostic approach was shown to be unreliable for detecting intestinal dehiscence postoperatively?

A. Postoperative abdominal ultrasound
B. White blood cell count of abdominal fluid
C. Cytology for degenerate neutrophils and bacteria
D. Whole blood-to-effusion glucose/lactate differences (WB-EGD/WB-ELD)
E. All of the above

Answer: All of the above

Explanation: None of these diagnostic tests reliably distinguished dehiscence from non-complicated recovery in postoperative SP patients.
In O'Marra 2026 et al., on perioperative septic peritonitis, what factor was consistently associated with improved survival in dogs undergoing surgery for septic peritonitis?

A. Use of NSAIDs for analgesia
B. Delaying enteral nutrition until discharge
C. Use of synthetic colloids for oncotic support
D. Enteral nutrition initiated within 24–48 hours postoperatively
E. Avoidance of postoperative antibiotics

Answer: Enteral nutrition initiated within 24–48 hours postoperatively

Explanation: Early enteral nutrition is associated with improved outcomes and decreased hospitalization in both people and dogs with septic peritonitis.
In O'Marra 2026 et al., on perioperative septic peritonitis, which of the following is a recommended strategy to mitigate intra-abdominal hypertension in at-risk veterinary patients?

A. Prophylactic antibiotics
B. Prolonged fluid resuscitation
C. Open abdomen management
D. Avoiding sedation and neuromuscular blockade
E. Use of NSAIDs for inflammation

Answer: Open abdomen management

Explanation: IAH can compromise healing and perfusion. Recommended strategies include decompression techniques, sedation, and open abdomen management.
In O'Marra 2026 et al., on perioperative septic peritonitis, what was the most commonly reported cause of recurrent septic peritonitis in dogs?

A. Inadequate antimicrobial spectrum
B. Inappropriate fluid therapy
C. Dehiscence of gastrointestinal surgical site
D. Intraoperative contamination
E. Delayed surgical timing

Answer: Dehiscence of gastrointestinal surgical site

Explanation: Gastrointestinal dehiscence was the most common cause of recurrent septic peritonitis, which carried a poor survival rate.

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