PERITONITIS

This is inflammation of the peritoneum. Appreciate that peritonitis could be due to tuberculosis and could also be aseptic. The aseptic type is usually due to chemical irritants like pancreatic juices, etc. Peritonitis usually ends up producing adhesions that may cause future bowel obstructions of varying degrees.

Clinical Features

  • Presentation is
    • Acute tender abdomen
    • Abdominal distension
    • Altered bowel sounds
    • Guarding
    • Rigidity
    • Rebound tenderness
    • Fever.
  • Complications of peritonitis include the following:
    • Abscess formation.
    • Multiple organ failure.
    • Site infection following surgery.
    • Wound dehiscence.
    • Enterocutaneous fistulae.

Investigations

  • Full haemogram, PCV.
  • Urea and electrolytes.
  • Abdominal radiograph (erect AP and dorsal decubitus) – may show air fluid levels or air under the diaphragm in case of perforated viscera.

Management – General

  • Correct fluid and electrolyte imbalance. These are usually disturbed by the movement of fluid and electrolytes into the third space. The disturbance could arise or be made worse by vomiting and/or diarrhoea.
  • Consider nasogastric suction, which is usually necessary because of organ hypotonia and dilatation.
  • Use antibiotics to cover a broad spectrum of bacteria. Combinations advised in order to get the appropriate cover are cefuroxime 750mg 8 hourly + metronidazole
    500mg IV 8 hourly for 7 days.
  • Alleviate pain only once a diagnosis has been made. Analgesic recommended in such a situation: diclofenac 75mg IM 12 hourly as needed.

Management – Specific

  • Exploratory laparotomy is a must in secondary peritonitis in order to repair or remove the diseased organ. Laparotomy also facilitates peritoneal lavage of the necrotic debris and pus.
  • Direct attention at the primary cause of peritonitis.
  • Send pus for culture and sensitivity.