Peritonitis in adults

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Treatment options

Treatment of peritonitis involves surgical intervention, during which the doctor stops the effect of the provoking factor and removes excess fluid from the abdominal cavity.

The operation is performed by laparotomy, which is based on direct penetration into the peritoneum. At the first stage, the doctor prepares: he introduces an anesthetic drug and begins to rinse the gastrointestinal tract. After completing the preparatory measures, the doctor creates an incision on the front wall of the abdomen.

The second stage of the operation involves eliminating the inflammatory focus. Depending on the cause that provoked the formation of peritonitis, the doctor removes the appendix or ulcerative formation, restores the walls of the diseased digestive organ, and removes the gallbladder. After stopping the source of inflammation, the doctor rinses the abdominal cavity a second time and disinfects it with an antiseptic solution.

At the third stage, the doctor performs intestinal decompression, which involves removing excess gases and pathogenic exudate from its cavity. This procedure is carried out through a thin drainage tube, which is inserted into the peritoneum through the oral cavity. Once decompression is complete, the doctor carefully sutures the incision.

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Local serous-fibrinous/serous peritonitis

Local peritonitis is an inflammatory process of the peritoneum, limited to a specific area and localized around the organ that is the cause of the pathological process.

Local serous-fibrinous peritonitis occurs due to the development of adhesions and the ability of the peritoneum to limit the inflammatory process. Most often, local serous peritonitis is closely associated with an acute disease of one or another abdominal organ (stomach, duodenum, gallbladder, segment of the small or large intestine, pelvic organs, kidneys). The main reason for the development of such peritonitis is perforation due to peptic ulcer of a hollow organ (stomach, duodenum, ulcerative colitis, gangrenous appendicitis, etc.). Local inflammatory processes in the abdominal cavity occur much more easily than generalized peritonitis; in some cases, patients even remain able to work. However, even with this course of the disease, untimely diagnosis and treatment can lead to a destructive process and the formation of abscesses in the abdominal cavity.

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Diagnostics

Making a diagnosis of serous fibrinous peritonitis is associated with certain difficulties, so this process should only be carried out by a qualified doctor. At the Yusupov Hospital, specialists every day encounter various emergency conditions that require immediate diagnosis and treatment. The hospital has innovative equipment that is successfully used for diagnostic purposes to obtain results as quickly as possible.

After collecting anamnestic data, to complete the examination, doctors use:

• Palpation and auscultation to determine the characteristic symptoms of the disease. When listening to bowel sounds, it is due to the accumulation of free fluid in the abdominal cavity. Noises are usually weakened or completely absent.
• X-ray examination of the abdominal organs. A characteristic sign of a subphrenic ulcer is the presence of a layer of air. A specific symptom of “cups” is with intestinal obstruction.

Peritonitis of the abdominal cavity in an adult

Peritonitis is an inflammation of the peritoneum caused by various reasons and accompanied by functional, structural changes in the organs and systems of the body. Peritonitis belongs to a group of acute surgical conditions collectively called “acute abdomen.”

The immediate cause of peritonitis in the vast majority of cases is an infection that causes inflammation. Aseptic peritonitis associated with the leakage of sterile biological fluids into the abdominal cavity is considered such only at the onset of the disease. After some time, infection inevitably occurs.

An example of true aseptic peritonitis is inflammation of the peritoneum in systemic connective tissue diseases caused by an autoimmune process.

Peritonitis begins abruptly, acute pain, chills, fever, feeling of fullness in the abdomen

Surgical treatment in such cases is usually not required. In most cases, peritonitis is caused by gram-negative and gram-positive intestinal flora. A specific infection can also cause peritonitis.

Symptoms of abdominal peritonitis in adults

Peritonitis begins abruptly - acute pain, chills, fever, a feeling of fullness in the abdomen, bloating, tension in the abdominal muscles, tachycardia and shortness of breath. The symptoms of peritonitis largely depend on the underlying cause. Based on this, clinical manifestations are very diverse. Depending on the time of onset of symptoms, there are several stages of peritonitis.

The reactive stage of peritonitis develops on the first day. It is characterized by severe pain, which at first can be clearly localized. Over time, the pain subsides a little, spreading throughout the abdomen. In addition to pain, the patient is worried about nausea, vomiting (first with water, then with bile) and a feeling of thirst. Gray complexion, cold sweat and disc-shaped abdomen are symptoms of generalized peritonitis in adults.

The toxic stage develops on the third day. The clinic is growing. Microcirculation is disrupted, manifested by cyanotic fingers and toes. Symptoms of dehydration appear. Consciousness is confused. In the classification of peritonitis by stage, the last place is occupied by thermal or irreversible. The patient's condition is extremely serious: severe dehydration, respiratory failure, pointed features (Hippocrates' face), no pulse in the peripheral vessels. As a rule, such a patient is in the intensive care unit.

The reactive stage of peritonitis develops on the first day and is characterized by severe pain, which at first can be clearly localized

Peritonitis prognosis for life

Prognosis for peritonitis cannot be unambiguous, since the outcome of such a severe complication is largely determined by the timing of emergency surgery and the general health of the patient.

A favorable outcome of the disease is possible in 90 percent of cases with surgery performed within a few hours after gastric or intestinal contents enter the abdominal cavity. If surgery is performed during the day, the chance of a favorable outcome is reduced to 50 percent. When surgical treatment is performed after the third day, the patient’s positive chances do not exceed 10 percent.