Causes of peritonitis of the abdominal cavity. Acute inflammation of the peritoneum

A slightly different mechanism is observed in cholecystitis and cholelithiasis. In this case, sweaty biliary peritonitis develops. In this case, there is no destruction or rupture of the gallbladder. The main mechanism is the slow leakage of bile into the peritoneal cavity. In this case, the reaction of the peritoneum to the aggressive action of bile ( bile contains bile acids) is proportional to its quantity. Since bile does not pour out immediately, but slowly sweats, its amount may initially be insignificant. The clinical picture in this period is blurred, and classic symptoms may be absent. However, as you gradually sweat, the volume of bile increases. When a large volume of bile irritates the peritoneum, a classic picture of peritonitis appears.

With a simultaneous massive outflow of bile, for example, with a rupture of the gallbladder, peritonitis develops quickly with the phenomenon of abdominal shock. The degree of the reactive process is influenced not only by the amount of bile and the rate of its outflow, but also by the nature of the bile.

Abdominal injuries

As a result of open and closed injuries, post-traumatic peritonitis develops. At open injuries In the abdominal cavity, direct infection of the peritoneum occurs. Thus, through a defect in the abdominal wall, direct contact of the non-sterile environment with the peritoneal cavity occurs. Bacteria penetrated from the air become a source of inflammation. In closed injuries, the mechanism of development of peritonitis is due to a violation of the integrity of the internal organs. Thus, closed abdominal injuries may be accompanied by rupture of the spleen and other internal organs. In this case, their contents, poured into the peritoneal cavity, become the cause of peritonitis.

In addition, pathologies of the pancreas can be the cause of peritonitis ( in one percent of cases), spleen and bladder.

Causative agents of bacterial peritonitis

The cause of infection in peritonitis can be a variety of bacteria. This can be either a specific microbial flora or a nonspecific microflora of the intestinal tract.

Microorganisms that can cause peritonitis

Specific flora	Nonspecific flora
hemolytic streptococcus; gonococci; pneumococci; Mycobacterium tuberculosis.	aerobic microorganisms ( those that use oxygen in the process of their life).	anaerobic microorganisms (those that do not use oxygen in the process of their life activity).
	coli ( in 60 percent of cases); proteus; Klebsiella; enterobacter; staphylococcus and streptococcus ( 20 percent or more of cases).	clostridia; bacteroides; fusobacteria; peptococci and peptostreptococci.
In 50–60 percent of cases of peritonitis, microbial associations are observed. They are presented simultaneously by 2 or 3 pathogens. Most often these are Escherichia coli and staphylococcus, as well as anaerobic non-clostridial flora.

Causes of aseptic peritonitis

In aseptic peritonitis, the peritoneum is irritated not by the bacterial flora, but by such aggressive agents as blood, urine, gastric juice or pancreatic juice. This type of peritonitis is also called toxic-chemical, because the action of enzymes and acids contained in the blood or pancreatic juice is similar to a chemical burn. It is worth noting that aseptic peritonitis itself does not exist for long. Within 6–8 hours, bacterial flora joins it, and it becomes bacterial.

A special type of aseptic peritonitis is barium peritonitis. This type of peritonitis is extremely rare, but its mortality rate exceeds 50 percent. It develops as a result of barium leaving the gastrointestinal tract. This occurs when performing X-ray diagnostic methods with barium contrast ( for example, during irrigoscopy).

Types of peritonitis

There are many types of peritonitis, which are classified according to different criteria.

Criterion	Type of peritonitis
Because of	traumatic; perforated ( or perforated); postoperative; infectious.
By traumatic factor	bacterial; aseptic.
According to the mechanism of infection	primary; secondary.
By degree of distribution	local ( or local); diffuse; total.
According to the nature of the inflammatory content	purulent; serous; hemorrhagic; fibrinous.
By the presence of exudate	exudative ( he's wet); dry.
By type of infectious agent	streptococcal; tuberculous; clostridial; gonococcal.

From a clinical point of view, the most important and informative classification is according to the degree of distribution and the nature of the inflammatory content. Distinguishing peritonitis by type of infectious agent is very important for prognosis of the disease. Knowing the type of microorganism, you can select the treatment as accurately as possible. However, in practice, identifying the etiological factor ( that is, the causative agent of peritonitis) very hard.

Exudative peritonitis

Exudative peritonitis is one in which inflammatory fluid accumulates in the peritoneal cavity. Normally, a small amount of fluid is present in the cavity, which ensures the absence of friction between the visceral and parietal layers of the peritoneum. This liquid is aseptic, meaning it does not contain bacteria.

When, as a result of various mechanisms, an infection enters the cavity, destruction of the surface layer of the peritoneum occurs. This leads to intense exudative processes, which are accompanied by the accumulation of inflammatory fluid. Initially, the volume of fluid that accumulates in the peritoneal cavity is small. However, as it progresses pathological process it increases. The amount of liquid can vary from several tens of milliliters ( 50 - 70 ) up to several liters ( 1 – 2 ). The main key point in the development of the disease is intoxication. It is known that the total area of ​​the abdominal covering is equal to the total area of ​​the skin, that is, approximately 2 square meters. All toxins that accumulate in the cavity penetrate the blood and very quickly lead to intoxication of the body. Together with the bloodstream, bacteria and their toxins are carried to the organs, affecting them. As a result of such generalized dissemination of infection, multiple organ failure develops.

A feature of exudative peritonitis is that simultaneously with the accumulation of fluid in the peritoneal cavity, the body loses water. It is known that all water in the body is divided into intracellular and extracellular fluid. Intracellular fluid refers to the fluid contained in tissue cells. Extracellular fluid includes interstitial fluid ( fluid between cells) and intravascular ( blood plasma) liquid.

IN healthy body the intracellular volume of fluid accounts for 60 - 65 percent, the extracellular part - 40 - 35. However, with peritonitis, a pathological third space is formed. This space is nothing more than the peritoneal cavity. In it, due to hemodynamic disturbances ( impaired vascular tone, increased permeability of the vascular wall) fluid accumulates both from the vascular bed and from the tissues. Thus, the body loses water and experiences dehydration. This condition is complicated by vomiting, which also results in loss of fluid and electrolytes.

Depending on the nature of the inflammatory fluid, serous, purulent, hemorrhagic or fibrinous peritonitis is distinguished.

Serous peritonitis
With serous peritonitis, fluid accumulates in the peritoneal cavity, which is poor in protein and cellular elements. Such inflammation is observed in the first 2–3 days of the disease. After this, the fibrin in it heats up and it becomes serous-fibrinous. If the purulent flora is activated, then serous peritonitis evolves into purulent peritonitis.

Fibrinous peritonitis
With fibrinous peritonitis, a large amount of fibrin accumulates in the inflammatory fluid. This leads to the formation of fibrin films that cover the layers of the peritoneum. This type of peritonitis can develop into adhesive peritonitis.

Hemorrhagic peritonitis
This form of peritonitis occurs when blood that has penetrated into the peritoneal cavity is mixed with the fluid. This blood can form during injuries ( traumatic peritonitis) or pour out when organs are perforated.

Dry peritonitis

With dry peritonitis, a small amount of fluid is observed in the peritoneal cavity. The difference between this liquid is great content it contains fibrinogen. Fibrinogen is a protein that forms the basis of a blood clot during clotting. Its concentration increases during inflammatory reactions, as well as during epithelial injuries. Upon contact with the sheets of inflamed peritoneum, fibrinogen is converted into fibrin. Fibrin thickens the inflammatory fluid, making it thicker, due to its physicochemical properties. It also falls out on the surface of the peritoneum in the form of threads and villi, and forms films on the surface of the internal organs. These fibrin structures subsequently stick together. For this reason, dry peritonitis is also called adhesive peritonitis.

On the one hand, this process is carried out by the body for a protective purpose. Indeed, with the formation of adhesive fibrin structures, the site of inflammation is delimited. Dry peritonitis is less likely to be diffuse. However, at the same time, due to the massive adhesive process, adhesions are formed between the peritoneum and the intestines. This type of peritonitis often occurs violently. Despite the absence of a large effusion in the peritoneal cavity and the limited nature of the process, it occurs with severe hypovolemia ( decreased blood volume).

Dry peritonitis is often observed with tuberculous etiology of this disease. In this case, the layers of the peritoneum swell sharply, and tuberculous tubercles form on their surface. In this case, there is practically no liquid in the peritoneal cavity, or it is contained in small quantities. As the bumps progress, they begin to spread to the intestines and other organs. Sometimes they become so thick and compacted that they deform the organ.
With dry peritonitis, disseminated intravascular coagulation syndrome often develops.

Purulent peritonitis

This type of peritonitis is caused by putrefactive flora such as staphylococci, gonococci, E. coli, and most often by an association of these microorganisms. As a rule, purulent peritonitis occurs in an exudative form. But there is also a purulent-caseous form, in which multiple localized ulcers form in the peritoneal cavity. Most often, purulent peritonitis develops as a result of perforation of purulent appendicitis or other organs.

Purulent peritonitis occurs very quickly and is characterized by a pronounced intoxication syndrome. Many representatives of purulent flora produce toxins that are tropic ( more preferable) to various types of fabrics. Some toxins are particularly selective for the epithelium of the vascular wall. Penetrating into the bloodstream, they cause swelling and dilation of blood vessels, leading to numerous hemorrhages in the organs. The phases of peritonitis in its purulent form are sharply expressed, and no clinical signs are observed. Symptoms of general intoxication and disturbances of water and electrolyte metabolism prevail. Often, especially with streptococcal peritonitis, confusion and delirium are observed. Purulent peritonitis is characterized by its high mortality rate. Chronic and sluggish forms of purulent peritonitis are extremely rare.

Tuberculous peritonitis

Peritonitis caused by Mycobacterium tuberculosis is called tuberculosis. This is the most common form of chronic peritonitis. Tuberculous peritonitis primarily affects children. However, this is a common occurrence among adults. In 99.9 percent of cases, this is secondary peritonitis, which developed during dissemination of the pathogen from the primary focus. In children, such sites are the lungs and lymph nodes. Among women ( The ratio of men to women with this pathology is 1 to 9) are the internal genital organs. This ratio of men and women is explained by the fact that in women the uterus communicates with the peritoneal cavity through the fallopian tubes. This message ensures the rapid spread of mycobacteria into the peritoneal cavity during tuberculosis of the internal genital organs.

Tuberculous peritonitis can occur in both dry and exudative forms. The peculiarity of this type of peritonitis is that it can occur in blurred clinical forms without clearly defined phases. Symptoms of intoxication ( fever, weakness) can exist for weeks and even months. Such a sluggish course of peritonitis is accompanied by a violation of metabolic, endocrine and other functions of the body. To the characteristic symptoms of peritonitis are added the symptoms of the underlying disease, that is, tuberculosis. The main symptoms are weight loss, prolonged fever, increased sweating, periodic cough and others. The acute course of tuberculous peritonitis is observed relatively less frequently.

In addition to these forms of peritonitis, there is so-called anaerobic peritonitis, which is caused by anaerobic flora. It develops as a result of gunshot wounds or as a complication of childbirth or abortion. Inflammatory fluid It has a fetid odor, and multiple abscesses develop in the peritoneal cavity. Distinctive feature Biliary peritonitis is a mild irritation of the peritoneum. Despite the general signs of intoxication, classic local symptoms ( “board belly”, muscle tension) are not expressed.

Local and general symptoms of peritonitis

Symptoms of peritonitis are divided into local and general. Local symptoms include those that develop in response to irritation of the peritoneum ( inflammatory exudate, blood, bile). These symptoms develop as a protective mechanism, and the area of ​​their localization depends on the area and location of the pathological focus.

Local symptoms of peritonitis are:

• pain;
• abdominal muscle tension;
• symptoms of peritoneal irritation detected during examination.

Pain

Pain is the very first symptom of peritonitis. Its nature and intensity depend on the cause of peritonitis. The most vivid and intense pain is observed with perforation of internal organs, for example, the stomach or duodenum. In this case, it appears sharply, suddenly, and in strength resembles a blow with a dagger ( described in medical literature as a dagger-like pain). The intensity of the pain syndrome is also influenced by the composition of the irritating substance. Thus, the most intense pain is observed with pancreatic necrosis or acute pancreatitis. Enzymes contained in pancreatic juice have a maximum irritating effect on the peritoneum, comparable to a burn. Severe pain can lead to painful shock and loss of consciousness. Sometimes the patient may become agitated. However, most often the pain limits the patient’s movements, forcing him to take a certain position. Abdominal breathing becomes difficult, infrequent and superficial.

The pain that appears is first localized and limited to the area where the pathological focus is located. However, after a couple of hours the pain becomes widespread. This is due to the spread of pathological contents throughout the abdominal cavity. At the same time, the opposite can also be observed. Initially diffuse pain can be localized.

Pain during peritonitis is caused by irritation of the peritoneum. After all, the peritoneum has rich innervation and is sensitive to any type of irritant. The transition from localized pain to diffuse pain is also explained by the transition of inflammation from the parietal layer of the peritoneum to the visceral one. The parietal layer of the peritoneum, which covers the walls, receives innervation from the corresponding abdominal walls. For example, the leaf covering the anterior abdominal wall is innervated by intercostal nerves. Therefore, the pain that arises in this case has a clear localization. At the same time, the visceral layer of the peritoneum is innervated by the autonomic nervous system. The pain that occurs when the visceral peritoneum is irritated does not have a clear localization, but is diffuse in nature.

Sometimes the pain can simply change location, which also means the transition of the inflammatory process. But in this case, the inflammatory process is not diffuse, but localized. For example, pain may be relieved for a while and intensified when urinating. This means that the pathological process has moved to the peritoneum covering the bladder. In diagnosis, it is important to find out the primary location of pain.
The disappearance of pain is an unfavorable sign of peritonitis. This may be due to the accumulation of large amounts of fluid in the abdominal cavity or paresis ( lack of peristalsis) intestines.

Abdominal muscle tension

Abdominal muscle tension, or muscle guarding, occurs almost simultaneously with pain. The appearance of this symptom is due to a reflex contraction of the abdominal muscles. Muscle tension also corresponds to the zone of innervation. Maximum muscle tension with the disappearance of all abdominal reflexes is observed when the ulcer is perforated. Such a belly is also called “board-shaped” in the medical literature. In this case, muscle tension is visible visually, even before palpation.

The voltage can also be local. For example, with effusion biliary peritonitis, the abdominal wall thickens in the area of ​​​​the gallbladder projection.
Muscle guarding is an early local symptom. At the same time, as intestinal paresis develops and exudate accumulates, it disappears. The absence of muscle tension can be observed in weakened patients, usually in the elderly.

Symptoms of peritoneal irritation revealed during examination

The classic objective symptom of peritoneal irritation is the Shchetkin-Blumberg symptom. The symptom reveals the presence of inflammation and irritation in the peritoneum.

Methodology
The patient is in a supine position with his knees bent ( for maximum relaxation abdominal wall ). The doctor slowly presses his hand on the area of ​​the anterior abdominal wall, where the inflammatory process is suspected. In this case, the patient notes pain. When the hand is suddenly removed, the pain increases sharply. This symptom is considered positive. If, when the hand is removed, the pain does not change its intensity, then the symptom is considered negative.

With pronounced muscle tension, the symptom is difficult to determine. Diagnosis is also difficult in cases where intestinal paresis has developed.

Big diagnostic value have common symptoms of peritonitis. They are caused by the penetration of toxins into the blood and general intoxication.

Common symptoms of peritonitis are:

• temperature;
• repeated vomiting;
• cardiopalmus;
• low pressure;
• decreased diuresis;
• dry skin and pointed facial features;
• signs of acidosis ( increase in acidity);
• confusion.

In the clinic of peritonitis, it is customary to identify several stages, which are characterized by their own symptoms.

Symptoms of peritonitis by stage

Reactive stage

The reactive or initial phase is characterized by the predominance of local symptoms and the initial development of general ones. Its duration ranges from several hours to several days. In acute purulent peritonitis, its duration is limited to 24 hours.

At this stage, the patient is in a forced position, usually lying on his back with his legs brought to his stomach. General symptoms such as fever and rapid heartbeat appear. The temperature is caused by the activity of bacteria and their penetration into the blood. The degree of temperature rise is directly proportional to the pathogenicity of microorganisms. So, with streptococcal and staphylococcal peritonitis, the temperature rises to 39 - 40 degrees Celsius. For tuberculosis - 38 degrees. Along with the rise in temperature, the number of heart beats increases. At this stage of the disease, this is associated with elevated temperature. It is known that for every degree raised, the heart increases the number of its contractions by 8 beats per minute.

Nausea and vomiting also occur at this stage. The patient's tongue becomes coated and dry. When examining the patient, shallow, gentle breathing is revealed. With moderate pain syndrome, consciousness is clear, with painful shock it is confused. Also at this stage, objective symptoms of peritoneal irritation, such as the Shchetkin-Blumberg symptom, are revealed.

Toxic stage

This stage lasts from 24 to 72 hours. General symptoms begin to prevail in it, which are caused by general intoxication, disturbances of water-electrolyte metabolism and metabolic disorders.
Toxins are carried throughout the body through the blood and lymph. They reach the liver and lungs first, resulting in liver failure and pulmonary distress. Breathing becomes frequent, shallow, and sometimes intermittent. The patient continues to vomit, and the vomit becomes foul-smelling.

The main complications at this stage are associated with dehydration and water-electrolyte disturbances. Due to disturbances in vascular tone and changes in the permeability of the vascular wall ( everything is caused by toxins) fluid seeps into the peritoneal cavity. A state of anhydremia develops, which is characterized by a decrease in fluid levels in the body. The patient is thirsty, which does not go away with drinking. The tongue becomes dry, coated with a brown coating. Blood pressure drops, and the heart rate compensatory increases to 140 beats per minute. At the same time, due to hypovolemia ( low blood pressure) heart sounds become dull and weak.
Frequent vomiting leads to the loss of not only water, but also body salts. Due to hypokalemia and hyponatremia, seizures or arrhythmia may occur.

The patient's condition worsens further when oliguria develops. At the same time, the daily volume of urine decreases from the norm of 800–1500 to 500 ml. It is known that all metabolic products are removed from the body with urine. These include urea, uric acid, indican. However, with oliguria they are not excreted, but remain in the body. This leads to even greater intoxication of the body.

At the same time, local symptoms of peritonitis become erased. Muscle tension disappears, and it is replaced by bloating. At this stage, intestinal paresis develops, which is characterized by the absence of peristalsis. The pain also subsides or completely disappears, which is associated with the accumulation of exudate in the peritoneal cavity.

If emergency measures are not taken, this stage may progress to the terminal stage.

Terminal stage

This stage develops 72 hours or more from the onset of the disease. It is characterized by dehydration and the development of a precomatous state. The patient's face at this stage corresponds to the descriptions of Hippocrates ( facies Hippocratica). The features of such a face become sharper, the eyes and cheeks are sunken, and the complexion acquires an earthy tint. The skin becomes very dry and tight to such an extent that the temples are pressed in. Consciousness is confused, the patient most often lies motionless. The abdomen is strongly inflated, its palpation is painless. The patient's pulse is threadlike, breathing is intermittent.
Today, the terminal stage is, of course, extremely rare.

The severity of local and general symptoms of peritonitis depends on the extent of its spread and the cause of the disease. The classic staged course is observed with diffuse peritonitis. In localized forms, the symptoms are not so pronounced.

Symptoms of chronic peritonitis

The classic symptoms of peritonitis in its chronic form are usually erased and not expressed. The patient does not complain of acute pain, vomiting or muscle tension. Therefore, for a long time this type of peritonitis can proceed unnoticed.
At the same time, the main symptoms are associated with long-term, chronic intoxication of the body.

Symptoms of chronic peritonitis are:

• weight loss;
• increased sweating;
• prolonged low-grade fever;
• periodic constipation;
• periodic abdominal pain.

Weight loss and increased sweating are persistent symptoms with chronic tuberculous peritonitis ( the most common form of chronic peritonitis). These symptoms are caused by intoxication of the body with decay products of mycobacteria.

Other symptoms of chronic peritonitis are caused by adhesions. Thus, chronic peritonitis most often occurs in a dry form, which is characterized by an adhesive process. The adhesions that form in this case tighten the intestinal loops and disrupt its motor activity. Thus, periodic intestinal obstruction syndrome develops. The patient suffers from periodic constipation, which becomes more frequent as the disease progresses. Pain in the abdomen and periodic bloating also appear. As the adhesive process spreads, symptoms become more frequent and severe.

Diagnosis of peritonitis

Diagnosis of peritonitis is based on anamnestic data and clinical picture. History data ( medical history) are especially important in chronic forms of peritonitis. Knowing what the patient was sick with before or what he is sick with now, we can most accurately predict the location of the primary infection. In chronic peritonitis, objective data revealed during examination are scarce and therefore the doctor may resort to additional methods examinations. One such examination is diagnostic laparoscopy. This diagnostic method allows you to visually examine the peritoneal cavity without making large incisions on the abdomen, as during surgery. During this manipulation, the doctor examines the layers of the peritoneum through a tube combined with a lens and assesses their condition. As a rule, in chronic peritonitis, the peritoneum is covered with fibrin films, and adhesions form between its layers.

In acute and diffuse peritonitis, diagnosis is not difficult. As a rule, the patient's complaints and objective data revealed during examination are sufficient for diagnosis. The main symptoms that the doctor identifies during examination are associated with irritation of the peritoneum. These symptoms are muscle tension, a positive Shchetkin-Blumberg symptom.

Treatment of peritonitis with medications

The mortality rate of peritonitis today is still high, so the problem of treatment is very urgent. Since peritonitis in 99 percent of cases is a secondary disease, its treatment should begin with eliminating the root cause. As a rule, it consists of surgery to remove a burst appendix, suturing a perforated ulcer, or removing a purulent gallbladder. At the same time they carry out drug treatment, aimed at correcting all those disorders that develop during peritonitis. Thus, the treatment of peritonitis should be comprehensive and combine various methods.

Treatment of peritonitis with medications is aimed at eliminating the infection ( causing peritonitis), for correction metabolic disorders, as well as to prevent the development of complications.

Group of drugs	Representatives	Mechanism of action	How to use
Antibiotics Antibacterial therapy is the mainstay in the treatment of bacterial peritonitis. Since the most common cause of peritonitis is a microbial association of 2 or 3 organisms, it is advisable to prescribe broad-spectrum antibiotics.	From the penicillin group: benzylpenicillin; ampicillin; methicillin. From the group of aminoglycosides: kanamycin; gentamicin. From the group of macrolides: sigmamycin; oletethrin.	They disrupt the synthesis of cell wall components, thus preventing further proliferation of bacteria in the peritoneal cavity. Antibiotics from the aminoglycoside group block the synthesis of proteins necessary for bacteria to function.	For moderate peritonitis, antibiotics are mainly prescribed intramuscularly. As a rule, loading doses of antibiotics are prescribed. Benzylpenicillin - 15,000,000 units each ( units of action) per day, ampicillin and methicillin - 3 to 4 grams, gentamicin - from 2 to 3 mg per kg of body weight. The daily dose is divided into 2–4 doses. In severe cases and in cases of septic shock, antibiotics are prescribed intravenously.
Infusion solutions They are used to restore lost fluid, as well as to prevent dehydration and hyperthermia.	5 and 25 percent glucose solution: refortan; perftoran.	Due to their high osmolarity, these solutions retain fluid in the vascular bed. Replenish lost water and salts of the body.	All these drugs are prescribed intravenously ( extremely rarely - intermittently). The volume of the prescribed solution is determined individually based on the amount of fluid lost by the body.
Detoxification agents and sorbents This group of drugs is used to remove toxins and bacteria from the body. Medicines are necessary to prevent the development toxic shock and other complications.	hemodesis.	Binds toxins that have entered the blood from the peritoneal cavity and removes them.	The volume of the solution depends on the age and condition of the patient. On average, 200 to 500 ml are administered intravenously.
	10 percent calcium chloride solution.	Normalizes the permeability of the vascular wall ( which is impaired during peritonitis), thereby preventing toxins from penetrating through it.	10 ml 10 percent solution diluted in 200 ml of isotonic solution and administered intravenously.
Diuretics This category of drugs is used for forced diuresis. The method of forced diuresis is prescribed together with detoxification drugs and hypertonic solutions to quickly remove toxins from the body.	furosemide This drug is prescribed with caution, especially in cases of severe water and electrolyte disturbances.	Blocks sodium reabsorption, thereby increasing urine volume. It has a quick but short-term effect.	One or two ampoules of the drug are administered intravenously after the hypertonic solution has been administered. For example, at the end of a drip with 400 ml of 20 percent glucose or mannitol solution, inject 4 ml ( 40 mg) furosemide.
Antipyretics To eliminate fever.		They block the synthesis of substances that are involved in inflammation and increase the temperature.	Paracetamol – 500 mg ( one tablet) 4 times a day. Ibuprofen - 400 mg each ( one tablet) 2 – 3 times a day.
Antiemetic drugs Used in the treatment of peritonitis to eliminate symptoms such as nausea and vomiting.	metoclopramide.	It has a tonic effect on the muscles of the gastrointestinal tract. Blocks receptors of the vomiting center and, thereby, has an antiemetic effect.	Administer intravenously or intramuscularly at 10 mg ( 2 ampoules) two or three times a day. Maximum daily dose equals 60 mg.
Anticholinesterase drugs Used to restore intestinal motor function and prevent paresis.	ubretid; Prozerin.	They increase the tone of the intestinal muscles and enhance peristalsis, preventing the development of paresis.	Ubretide is administered intramuscularly, once at a dose of 0.5 mg ( one ampoule). A second injection is given only after 24 hours. Prozerin is administered subcutaneously in a dose of 1 ml of a 0.05 percent solution twice a day.
Anticoagulants Used to prevent thrombosis, which is characteristic of purulent peritonitis.	heparin.	Reduces platelet aggregation, preventing the formation of blood clots. It also reduces the permeability of the vascular wall.	Can be used both intravenously and subcutaneously. It is also prescribed after surgery. The dose ranges from 25,000 to 50,000 units per day.
Anabolic drugs In patients with peritonitis, the rate of catabolic ( decay process) reactions are maximally increased. Therefore, drugs are prescribed that reduce this process.	In order to activate anabolic processes, anabolic steroids are prescribed: retabolil; insulin along with glucose.	Retabolil activates anabolic processes, mainly due to the synthesis of proteins in the body. Insulin increases energy processes in the body.	Retabolil is administered intramuscularly at 100–200 mg for men, 50–100 mg for women once a week. Based on the calculation that one unit of insulin is per 5 mg of glucose, 250 to 500 ml of a 10 percent glucose solution is administered intravenously along with insulin.

Treatment of peritonitis should be individualized. It is necessary to take into account the peculiarities of the course of the pathological process, the form of peritonitis ( dry or wet), as well as an etiological factor. The latter plays a decisive role in the effectiveness of treatment. So, for tuberculous peritonitis, anti-tuberculosis drugs are prescribed - isoniazid, rifampicin, ethambutol. If anaerobic flora is suspected - lincomycin, trichopolum, gentamicin, and also hyperbaric oxygen therapy (high pressure oxygen supply). For aseptic peritonitis caused by acute pancreatitis, antienzymes are prescribed - contrical. For diffuse forms of peritonitis, the technique of washing the peritoneum is used ( peritoneal dialysis).

It should be noted that the use of painkillers for peritonitis is contraindicated. Firstly, painkillers blur the clinical picture, which is especially dangerous in acute period diseases. And this applies to all pathologies related to the “acute abdomen” section in surgery. Secondly, most painkillers weaken intestinal motility, thereby accelerating the development of intestinal paresis. It is also not allowed to administer laxatives, which contribute to the spread of the pathological process.

Surgery for peritonitis

When is surgery needed for peritonitis?

Detection of peritonitis is an absolute indication for emergency surgery. The course of the procedure depends on the cause that provoked the inflammation of the peritoneum, but in all cases the operation pursues the same goals and is carried out according to a certain algorithm.

The goals of surgical intervention for peritonitis are:

• elimination of exudate ( fluid released from blood vessels during inflammation) and infected tissues;
• resection or isolation of the source of infection;
• decompression ( release from liquids and gases) gastrointestinal tract;
• sanitation of the abdominal cavity.

The stages of surgery for inflammation of the serous covering of the peritoneum are:

• preoperative preparation;
• providing access;
• elimination or delimitation of the source of infection;
• abdominal lavage;
• intestinal decompression;
• drainage ( creating conditions for a constant outflow of content) abdominal cavity;
• suturing the wound.

Preparing for surgery

The main task of preoperative preparation is to correct impaired body functions.

The stages of preparatory therapy for the patient are:

• intravenous infusion of drugs;
• emptying the gastrointestinal tract;
• anesthesia.

Medication preparation of the patient
The nature of infusion therapy depends on the age and weight of the patient and the presence of concomitant diseases. In some cases, venous catheterization is advisable, which allows you to increase the speed of infusions and better control the process.

The goals of intravenous influence are:

• Replenishment of circulating blood volume.
• Correction of central and peripheral circulatory disorders.
• Ensuring the necessary concentration of antibiotics in tissues to reduce the spread of infection and prevent septic shock. In case of severe multiple organ failure syndrome and unstable blood circulation, the patient is given artificial ventilation.

Cleansing the gastrointestinal tract
If peritonitis is diagnosed early stage, a single gastric emptying is performed using a tube. For more advanced processes, the probe is left in place for the entire recovery period after surgery. Cleansing the lower intestines is carried out using enemas.

Anesthesia
Anesthesia during surgical treatment of peritonitis is carried out on the basis of multicomponent anesthesia and the use of muscle relaxants. Spinal anesthesia has recently been widely used. A mandatory step in pain relief is novocaine blockade. This procedure reduces the need for narcotic analgesics. Novocaine also helps improve tissue trophism and eliminate reflex vascular spasm, which ensures earlier restoration of the functionality of the gastrointestinal tract.

Incision during surgery
Surgical intervention for inflammation of the serous membrane of the peritoneum is performed using a median laparotomy ( an incision is made along the linea alba of the abdomen, from the lower end of the sternum to the pubis). This type laparotomy provides access to all areas of the abdominal cavity. Depending on the location of the source of infection, the incision made can be expanded in the required direction. Correction of an abdominal wound using special retractors provides the opportunity to quickly and with a minimal level of injury gain access to any part of the abdominal cavity. In cases where widespread purulent peritonitis is diagnosed only during an operation that is performed from another incision, the doctor switches to a median laparotomy.

Removing or delimiting the cause of peritonitis
Elimination of the source of peritonitis is the main goal of the operation. The doctor’s actions at this stage of the operation depend on which organ is the source of the infection. If the cause of inflammation is an organ, the removal of which is possible ( appendix or gallbladder), then resection of this organ is performed. If peritonitis causes perforation of a hollow organ, it is sutured. The affected area of ​​the gastrointestinal tract can also be removed with a colostomy or enterostomy ( methods of bringing out thin or colon ) or isolation of the source of infection. For peritonitis that occurs after intestinal surgery due to failure of the anastomotic sutures ( connection of two hollow organs) in some cases non-radical operations are performed. Such manipulations include suctioning out purulent contents using drainage tubes, isolating the source of peritonitis using tamponing, and removing the intestinal anastomosis to the outside.

Abdominal cleansing
Rinsing the abdominal cavity with special solutions reduces the number of pathogens in the exudate and helps eliminate the infection more effectively. In order to maintain the integrity of the serous layer, the use of gauze pads to remove pus is avoided. Also, due to the risk of disruption of the serous cover, dense deposits of fibrin are not eliminated ( substance that is formed when blood clots). The compositions that are used for washing are pre-cooled to a temperature that varies from +4 to –6 degrees. This procedure allows you to achieve vasoconstriction and reduce the intensity of metabolic processes, the level of which increases sharply in this disease.

Bowel decompression
To remove accumulated fluids and gases from the intestines, into the small intestine through oral cavity pass a long probe with a large number of holes. The probe can also be passed through the rectum. If suction of the contents is not effective, the doctor performs an ileostomy ( passage of part of the small intestine out through an opening in the abdominal wall). The colon, if necessary, is drained through anus. In rare situations, a stoma is performed to install the probe ( a hole created artificially and brought to the anterior wall of the abdominal region) on the stomach or appendix.

Abdominal cleansing
Special hollow tubes are used to drain the abdominal cavity. Drains are inserted into the right and left area pelvis, on both sides of the diaphragm and under the liver. If during the operation purulent peritonitis was detected and the cause of the infection was eliminated, then peritoneal lavage is performed ( introduction of special drugs into the abdominal cavity through a catheter and its removal after some time). This procedure allows you to effectively clean the abdominal cavity.

Stitching surgical wound
The method of completion of the operation depends on how the residual infection is treated.

Options for suturing the surgical incision are:

• Application of a continuous suture without drainage– this method is used when the level of infection is low, when there is no risk of abscesses. In such cases, the expectation is that the body can independently cope with the infectious process with the help of antibiotics.
• Closing the incision with passive drainage– drainages are used to drain exudate and administer antibiotics.
• Bringing the edges of the wound closer together– used when installing drains near the abdominal wall to wash the peritoneum and remove pus.
• Open way – used in the presence of a large amount of pus or extensive inflammation of the tissues of the abdominal wall. With this method, exudate is removed through an open wound, which is covered with tampons.

Postoperative period

The patient's condition after surgery for peritonitis requires close attention, since inflammation is associated with factors such as anesthesia, surgical trauma and malnutrition.

The areas of postoperative therapy are:

• taking antibiotics to reduce the number of harmful microbes in the body;
• carrying out therapeutic measures aimed at detoxifying the body;
• correction of metabolic disorders;
• restoration of intestinal functionality.

Is hospitalization necessary to treat peritonitis?

Treatment of peritonitis requires hospitalization. Outpatient ( at home) treatment of peritonitis in any form is unacceptable. Peritonitis is acute surgical pathology with an unpredictable course, the mortality rate of which is very high. At any stage of this disease, complications may arise that will endanger the patient's life. Therefore, at the slightest suspicion of peritonitis, emergency hospitalization is necessary. After complex treatment in a hospital, long-term observation by a surgeon is necessary.

Nutrition for peritonitis

Diet therapy is an important link postoperative rehabilitation after peritonitis. Surgery causes a disruption in the functionality of the body, so the reserves of proteins, fats and carbohydrates are depleted. Therefore, the patient’s diet after peritonitis must be balanced and include all elements for normalization energy metabolism. Determination of the final diet ( composition, duration) depends on the cause that caused peritonitis. The postoperative period is divided into several stages, which determine the patient’s nutritional pattern.

In phases recovery period are:

• first ( early) – lasts from 3 to 5 days;
• second – duration from 2 to 3 weeks;
• third ( distant) – ends when the patient’s ability to work is fully restored.

Nutrition at the first stage

It is possible to provide full support to the patient after surgery with the necessary nutritional ingredients only with the help of artificial nutrition. To meet the body's protein needs and prevent complications, the patient is given parenteral feeding ( administration of nutrients intravenously). When intestinal peristalsis occurs, the patient is transferred to enteral nutrition ( administration of mixtures using a probe through the mouth, nose or a special hole in the abdominal wall). The composition of the diet and duration are determined by the physician depending on the general condition sick. Parenteral and enteral feeding can reduce the likelihood of complications and shorten the recovery period after peritonitis surgery.

Nutrition in the second stage

When stool appears and the body’s condition improves, the patient is transferred to natural nutrition. The main rule of feeding is the gradual introduction of new products and constant monitoring of the patient’s well-being.
For some period ( from 2 to 5 days) after finishing artificial feeding the patient is prescribed special diet with low energy value (up to 1000 kilocalories per day). The patient needs to consume approximately 20 grams of proteins and fats and 200 grams of carbohydrates per day. Amount consumed table salt should be limited to a minimum, and fluid intake should be at least 2 liters per day. The consistency of the dishes should be liquid or semi-liquid.

• jelly, jelly ( vegetable, fruit, meat);
• weak meat broth;
• boiled eggs ( soft-boiled);
• fruit and berry juices homemade;
• vegetable puree with butter.

If this diet is well tolerated and there is no loose stool, the patient is transferred to a more varied diet, which is followed throughout the entire period of treatment in the hospital.

The main diet of the second phase of rehabilitation after surgical treatment of peritonitis
The diet must satisfy all the patient’s nutritional needs and promote the healing of organs affected during surgery. Also, one of the key goals of the diet is to restore the functionality of the gastrointestinal tract.

Principles of creating a menu for a patient after treatment of peritonitis
High protein content – ​​sufficient amounts are included in the following products:

• eggs;
• meat ( lamb, beef, turkey, rabbit);
• fish ( saury, salmon, sardine);
• fish products ( caviar, cod liver);
• dairy ( hard and semi-hard cheeses, sour cream, cream).

Minimum dose of easily digestible carbohydrates - it is necessary to reduce the consumption of foods such as:

• sugar;
• marmalade;
• jam;
• butter and other products made from wheat flour;
• sugar substitutes.

Sufficient quantity complex carbohydrates– products that contain the required rate of these elements are:

• brown rice;
• carrot;
• eggplant;
• potato;
• legumes;
• dried apricots;
• prunes.

Balanced fat intake – recommended sources of fat after peritonitis are:

• vegetable oil (corn, sunflower, olive);
• butter;
• sour cream, cream, milk, cottage cheese;
• medium fat fish.

Also, nutrition in the postoperative period should help increase the body's resistance to infections and healing of the postoperative wound.

The rules of the basic diet are:

• Diet– should consist of 5 – 6 meals.
• Pauses between meals– no more than 4 hours. Dinner – 1 – 2 hours before going to bed.
• Food temperature– average. Excessively hot or cold food is excluded.
• Food consistency– liquid, mushy. When boiled, food may have a denser structure than porridge, but should be served pureed.
• Recommended heat treatment– boiling or steaming. The use of an oven is also allowed, but without forming a crust on the products.
• Rest after meals– if possible, especially during lunch hours, after eating, you should take a horizontal position for 15–30 minutes.
• Fluid intake– tea, milk and other drinks should be consumed 20–30 minutes after meals. The amount of liquid taken at one time should not exceed 1 glass.

So that the food consumed does not have an aggressive effect on the organs digestive system, it is necessary to exclude products that are strong secretion stimulants.

Products that provoke increased secretory activity of the stomach include:

• rich meat and vegetable broths;
• smoked, dried sausages;
• salted, marinated fish;
• industrial canned food;
• baked goods;
• tomato sauce, ketchup, soy sauce, mustard, horseradish;
• salted, pickled vegetables;
• sour, salty, spicy dressings for dishes;
• insufficiently ripe or sour fruits;
• stale plants and animals edible fats;
• chocolate;
• coffee, cocoa;
• drinks containing carbonic acid.

Products whose consumption should be minimal in the main diet include:

• products from whole grain – bread made from coarsely ground flour, durum pasta, whole grain porridge;
• vegetables– white cabbage, broccoli, peas, green beans, spinach, dried mushrooms;
• fruits– dates, gooseberries, currants, apples, bananas, grapefruits, oranges, avocados.

You should also consume foods that contain stringy meat or rough meat in minimal quantities. connective tissue animal origin ( skin, cartilage, tendons).

The daily norms for the chemical composition of the basic diet are:

• squirrels- 100g ( 60 percent animal origin);
• fats– from 90 to 100 grams ( 30 percent plant-based);
• carbohydrates– 400 grams;
• calorie content– from 2800 to 2900 kilocalories.

The amount of table salt consumed by the patient per day should not exceed 6 grams.

The diet of a patient with peritonitis should be rich in vitamins and microelements, the deficiency of which can be compensated with the help of vitamin and mineral supplements. The main indicator that you should focus on when drawing up a menu is the patient’s well-being. If, when eating certain foods, the patient experiences discomfort in the epigastric region, nausea or vomiting, such foods or products should be discarded.

• Bread– wheat products baked yesterday or dried in the oven.
• Soups– prepared with potato or carrot broth. Products such as cereals can be added ( needs to be boiled well), vegetables ( should be wiped), milk. You can season first courses with butter.
• Meat– cutlets ( steamed, boiled), casseroles, soufflés. Recommended beef, lamb ( low-fat), pork ( circumcised), chicken, turkey.
• Fish– use low-fat varieties for boiling or steaming in one piece. The skin is first removed. Also possible are cutlets or meatballs made from fish fillets, aspic.
• Dairy– milk, low-fat cream, low-fat kefir, cottage cheese, yogurt, fermented baked milk. The products can be consumed independently or used to prepare casseroles, mousses, and creams.
• Eggs– soft-boiled, steam omelettes.
• Porridge– boiled in water or milk from cereals such as buckwheat, semolina, rice.
• Vegetables– potatoes, carrots, beets. You can simply boil vegetables, make puree or pancakes from them ( steam), cutlets ( steam), soufflé.
• Finished goods– milk sausage, unsalted low-fat ham, children’s sausages, curd cheeses.
• Dessert– jelly, jelly, unsweetened compote.
• Beverages– juices from sweet berries diluted with water, weak tea, rosehip decoction.

Sample menu dishes for 1 day are:

• Breakfast– 1 soft-boiled egg, rice porrige with milk, tea.
• Late breakfast– granular ( non-acidic) cottage cheese, rosehip decoction.
• Dinner– potato soup without meat, steamed chicken cutlets and carrot puree, dried fruit compote.
• Afternoon snack- a decoction of wheat bran with dried bread.
• Dinner– boiled fish, boiled vegetable salad, tea with milk.
• 1 – 2 hours before bedtime– 1 glass of milk.

Nutrition in the third stage

In most cases, the third phase of the postoperative period coincides with discharge from the hospital and transfer to outpatient treatment. Gradually, new foods are introduced into the patient’s diet, while monitoring the body’s reaction.

The rules according to which the transition to a more varied diet is carried out are:

• reducing restrictions on the types of heat treatments used;
• gradual increase in caloric intake;
• replacing pureed food with solid foods.

Restrictions that must be observed until full recovery are:

• reduced sugar intake;
• minimal use of hot herbs and spices;
• reducing the amount of hard-to-digest food ( animal fats, legumes, fatty meats, highly fried foods).

It is necessary to continue to observe the principles of fractional nutrition, distributing daily norm calories ( from 2300 to 2500) in accordance with the rules of a healthy diet.

Principles of distribution daily calorie content are (data given as a percentage of total food):

• breakfast – 20;
• late breakfast – 10;
• lunch – 35;
• afternoon snack – 10;
• dinner – 20;
• late dinner – 5.

Prevention of dysbacteriosis after peritonitis

Prevention of dysbacteriosis is of great importance when recovering from peritonitis ( decrease in beneficial and increase in harmful bacteria in the intestines).

Nutritional rules that will help restore intestinal microflora are:

• Refusal or reduction in consumption of all types of sugar and its substitutes ( honey, maple syrup, corn syrup, glucose, fructose, maltose, sorbitol, sucrose).
• Avoiding foods prepared using fermentation processes ( beer, wine, cider, ginger ale).
• Minimum consumption of foods that may contain yeast and mold ( cheeses, vinegar, marinades, baked goods, raisins, kvass).
• Avoid foods that contain dyes, flavors, or flavor enhancers. A large concentration of these elements is found in fast food.
• Eating stewed carrots and beets. These vegetables contain pectin, a substance that has a sorbent ( suction) property and promotes the removal of toxins from the body.
• Inclusion of dairy and lactic acid products in the menu ( kefir, cottage cheese, yogurt, kumiss, milk). It should be noted that fermented milk products, the duration of which does not exceed 1 day, bring benefits to the body in the fight against dysbiosis. After 24 hours, saprophytic bacteria develop in kefir and cottage cheese, which inhibit intestinal function and can cause constipation.
• Consumption of foods enriched with lactobacilli and bifidobacteria. Fermented milk products such as bifidok, biokefir, and fermented milk lactobacterin are enriched with such elements.
• Introducing slimy soups and porridges made from buckwheat or oatmeal to the menu. These dishes improve intestinal function and prevent diarrhea.

Is it possible to treat peritonitis at home?

Peritonitis is a disease that requires immediate medical attention. From the onset of the development of the disease to the terminal phase, a short period of time passes, the duration of which does not exceed 3 days. Therefore, untimely diagnosis and surgery can cause the patient’s death.

With peritonitis, blood, urine, bile, feces, and stomach contents enter the abdominal cavity, causing the body to experience severe intoxication. It is possible to remove the source of infection and eliminate the consequences of peritonitis only in special clinical conditions using medical equipment and a wide range of medications. In the hospital, the patient is provided with adequate preoperative preparation, which makes it easier to endure surgery. After completion of the operation, the patient undergoes multi-level postoperative therapy to prevent complications. It is impossible to implement all stages of treatment of peritonitis at the appropriate level at home.

Consequences of peritonitis

The consequences of peritonitis include the development of numerous complications both during the illness itself and during the recovery period.

Complications of peritonitis in the acute period of the disease are:

• acute renal failure;
• pulmonary complications;
• toxic shock;
• dehydration of the body.

Acute renal failure

Acute renal failure is a severe consequence of peritonitis, which is characterized by a sharp decrease in kidney function. It is known that the main function of the kidneys is to remove toxic metabolic products from the body. Due to damage to the kidneys by bacterial toxins that spread through the bloodstream from the peritoneal cavity throughout the body, this function declines sharply. The result of this is the retention of these products in the human body.

The most dangerous waste product in our body is urea. Its increased content in the blood is called uremia. The danger of this condition lies in the fact that, being an osmotically active substance, it carries water with it. Easily passing through cell membranes, urea, penetrating into the cell, leads to cellular hyperhydration. In this case, the cell becomes swollen and swollen, and its functions are lost.

Also, urea can fall out and form crystals, which will subsequently be deposited in the organs. With renal failure, nitrogen bases are also retained in the body. The greatest danger is ammonia, which, due to its lipophilicity, easily penetrates brain tissue, damaging it.

Unfortunately, damage to kidney tissue is often irreversible. Therefore, acute renal failure can often develop into a chronic form. At morphological study in people who died from peritonitis, numerous necrosis is detected in the kidneys ( areas of necrosis) and hemorrhages.

Pulmonary complications

Pulmonary complications develop in the toxic stage of peritonitis, when toxins and bacteria from the peritoneal cavity are carried through the bloodstream throughout the body. Once in the lungs, they cause blood stagnation, disrupting the process of oxygen transfer into them. The main mechanism of damage is a decrease in surfactant synthesis ( a substance that prevents the lungs from collapsing). The result is acute distress syndrome, which is characterized by severe shortness of breath, cough and pain in the chest. Its severity is proportional to the severity of peritonitis. The further the underlying disease progresses, the more respiratory failure increases. The patient becomes cyanotic ( skin color turns blue), he registers rapid and shallow breathing, palpitations. Without correction of respiratory disorders, distress syndrome develops into pulmonary edema. Pulmonary edema is one of the most severe complications that can be fatal. This condition is characterized by the fact that the pulmonary alveoli fill with fluid instead of air. As a result, the patient begins to choke because he does not have enough air.

Toxic shock

Toxic shock is one of the reasons deaths with peritonitis. It develops in the toxic stage, when toxins spread from the source of inflammation throughout the body. It is known that one of the pathogenetic links in peritonitis is increased vascular permeability. Bacteria and their toxins easily enter the bloodstream through the damaged wall. Together with the blood, they spread throughout the body, causing multiple organ failure. First they enter the liver, then the lungs, heart and kidneys. At the same time, water rushes from the vessels into the peritoneal cavity, causing blood pressure to drop. If a very large amount of toxins enters the blood at the same time, then all these stages occur very quickly. The temperature rises sharply, the pressure drops, and the patient becomes confused. Simultaneous development of multiple organ failure progresses very quickly. Toxic shock has a very high mortality rate, which can develop within a few hours.

Dehydration

Dehydration or exicosis is characterized by a loss of fluid from the body of 5 percent of normal or more. With exicosis, there is a lack of water not only in the bloodstream, but also in all cells of the body. Since water is the source of life, it participates in all metabolic processes in the human body. Its deficiency affects the functioning of all organs and systems. Tissues that have lost water lose their functions. Severe damage to the brain, kidneys and liver develops.

Complications of peritonitis in postoperative period diseases are:

• infection postoperative suture;
• repeated peritonitis;
• intestinal paresis;
• adhesions.

These complications are the most common in the list of numerous consequences of peritonitis. Repeated peritonitis develops in one case out of a hundred. This complication necessitates repeat surgery. It can develop due to insufficient drainage of the operated cavity, inadequate antibiotic therapy, or for a number of other reasons. As a rule, repeated peritonitis is more severe and even more difficult to treat.

Infection of the surgical suture is also a common complication. The risk of its development is greatest in people who are overweight or have diabetes. Supuration of the suture is observed in the early postoperative period. The seam becomes red, swollen and painful. After a couple of days, pus begins to flow out of it. At the same time, the patient develops fever, chills, and general health worsens.

Intestinal paresis is manifested by the absence motor activity intestines. It is a serious complication because it is difficult to correct. Most often it develops with diffuse peritonitis or as a result of prolonged operations. In this case, the patient suffers from painful bloating and prolonged constipation. Intestinal paresis can also develop during the period of the disease itself. In this case, it complicates the diagnosis of peritonitis, since it does not give the classic symptoms of peritoneal irritation and muscle tension.

The adhesive process is almost inevitable with peritonitis. Any violation of the integrity of the peritoneum, including its inflammation, is accompanied by the development of adhesions. As a result, connective tissue cords are formed that connect the intestinal loops. The adhesive process develops in the late postoperative period. Adhesions can initially cause partial and then complete intestinal obstruction. Their manifestation is prolonged pain in the abdomen and constipation. The complexity of the adhesive process lies in the fact that in most cases it is necessary to re-open the abdominal cavity and remove adhesions. This is necessary in order to restore intestinal obstruction, since an advanced adhesive process tightens the intestinal loops so much that it blocks its obstruction.

The consequence of peritonitis is also prolonged exhaustion of the patient. His recovery continues for months. Patients may lose a significant portion of their body weight. This happens because with peritonitis there is an increased breakdown of all the building substances of our body ( proteins, fats, carbohydrates). This phenomenon is also called a “catabolic storm.” Therefore, patients who have suffered peritonitis are as exhausted and weakened as possible.

The mortality rate of peritonitis is still high. With purulent and diffuse peritonitis, according to various sources, it accounts for 10–15 percent of cases. The outcome largely depends on timely hospitalization. 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.

– local or diffuse inflammation of the serous covering of the abdominal cavity – the peritoneum. Clinical signs Peritonitis is caused by abdominal pain, muscle tension in the abdominal wall, nausea and vomiting, stool and gas retention, hyperthermia, and severe general condition. Diagnosis of peritonitis is based on medical history, identification of positive peritoneal symptoms, ultrasound, radiography, vaginal and rectal examinations, and laboratory tests. Treatment of peritonitis is always surgical (laparotomy, sanitation of the abdominal cavity) with adequate preoperative and postoperative antibacterial and detoxification therapy.

Changes in the general blood test during peritonitis (leukocytosis, neutrophilia, increased ESR) indicate purulent intoxication. Laparocentesis (puncture of the abdominal cavity) and diagnostic laparoscopy are indicated in cases that are unclear for diagnosis and allow us to judge the cause and nature of peritonitis.

Treatment of peritonitis

Detection of peritonitis serves as the basis for emergency surgical intervention. Treatment tactics in case of peritonitis, it depends on its cause, however, in all cases, during the operation, the same algorithm is followed: laparotomy is indicated, isolation or removal of the source of peritonitis, intra- and postoperative sanitation of the abdominal cavity, and decompression of the small intestine.

The surgical approach for peritonitis is a median laparotomy, which provides visualization and reach of all parts of the abdominal cavity. Elimination of the source of peritonitis may include suturing the perforation, appendectomy, colostomy, resection of a necrotic portion of the intestine, etc. All reconstructive interventions are postponed to a later date. late date. For intraoperative sanitation of the abdominal cavity, solutions cooled to +4-6°C are used in a volume of 8-10 liters. Decompression of the small intestine is achieved by inserting a nasogastrointestinal tube (nasointestinal intubation); Drainage of the colon is performed through the anus. The operation for peritonitis is completed by installing vinyl chloride drains into the abdominal cavity for aspiration of exudate and intraperitoneal administration of antibiotics.

Postoperative management of patients with peritonitis includes infusion and antibacterial therapy, prescription of immunocorrectors, transfusion of leukocytes, intravenous administration of ozonized solutions, etc. For antimicrobial therapy of peritonitis, a combination of cephalosporins, aminoglycosides and metronidazole is more often used, providing an effect on the entire spectrum of possible pathogens.

In the treatment of peritonitis, the use of extracorporeal detoxification methods (hemosorption, lymphosorption) is effective. Since most peritonitis is secondary, their prevention requires timely identification and treatment of the underlying pathology - appendicitis, gastric ulcers, pancreatitis, cholecystitis, etc. Prevention of postoperative peritonitis includes adequate hemostasis, sanitation of the abdominal cavity , checking the integrity of anastomoses during abdominal operations.

Inflammation of the peritoneum (peritonitis) develops when pathogenic microbes invade it or certain chemicals enter it. The peritoneum is a two-layer membrane that lines the abdominal cavity and surrounds the stomach, intestines and other abdominal organs. This membrane supports the abdominal organs and protects them from infection; however, sometimes the peritoneum itself can become infected with bacteria or other microorganisms. The infection usually spreads from organs within the abdomen. Inflammation can cover the entire peritoneum or be limited to only one abscess. A rupture anywhere in the gastrointestinal tract is the most in the usual way for infection to penetrate into the peritoneum. In most cases, microbes are transferred to the peritoneum directly from any inflammatory focus located in one or another abdominal organ ( acute appendicitis, cholecystitis, inflammation of the female genital organs, intestinal volvulus, etc.), as well as with penetrating wounds of the abdomen and perforation of the hollow organs of the abdominal cavity (perforation of the stomach and intestines, gall bladder, etc.). Less commonly, the infection is introduced hematogenously from an inflammatory focus (angina, etc.).

There are two forms of peritonitis: diffuse, when inflammation covers most of the peritoneum, and limited, in which inflammation spreads to a relatively limited area.

The most severe form is diffuse peritonitis, which develops as a result of the sudden entry of gastrointestinal contents into the abdominal cavity (when a hollow organ is perforated), or pus (when an abscess breaks through). In these cases, very severe acute pain in the abdomen suddenly appears. This is soon followed by nausea and vomiting. Vomiting or the urge to vomit is repeated incessantly. Initially, the vomit contains food debris, and then a greenish liquid appears. Abdominal pain increases and becomes unbearable. The slightest movement of the patient or touching the abdomen causes an exacerbation of pain. The stomach becomes tense. When palpated, the tension in the abdominal wall is clearly determined. The patient's general condition deteriorates sharply, skin become pale, pulse is frequent, breathing is shallow, respiratory excursions of the abdominal wall are sharply limited or absent. Body temperature rises. Moreover, the temperature in armpit significantly lower than in the rectum. In the future, intestinal paresis and bloating occur. During auscultation, bowel sounds in the abdomen are not heard. The patient's appearance changes sharply, the eyes become sunken, the nose becomes sharpened, the face becomes covered with cold sticky sweat, cyanosis appears, and the tongue becomes dry.

In cases where peritonitis develops as a result of the transfer of inflammation from one or another abdominal organ, the general condition and subjective complaints of the patient initially remain characteristic of an inflamed abdominal organ. But then a sharp deterioration occurs in the general condition. Abdominal pain becomes more diffuse, and peristaltic sounds are no longer heard. Palpation data are decisive for diagnosis in these cases. If earlier, pain and tension in the abdominal wall were determined in the area of ​​the primary inflammatory focus, then with peritonitis they quickly cover the entire abdomen. There is a sharp deterioration in the general condition of the patient.

With limited peritonitis, initially only symptoms characteristic of inflammation of a particular abdominal organ (appendicitis, cholecystitis, adnexitis, etc.) are determined. Only after some time do symptoms characteristic of limited inflammation of the peritoneum appear: pain and tension in the abdominal wall are noted not throughout the abdomen, but in some area of ​​it. In other areas, the abdomen remains softer, less painful, and tension in the abdominal wall is not expressed, or is slightly expressed.

Diagnostics

. Medical history and physical examination. . X-ray, ultrasound examination and CT scan belly. . Blood tests will show increased content white blood cells. . Exploratory surgery (laparotomy) may be necessary.

Treatment

Treatment is an urgent operation that eliminates the cause of peritonitis. Simultaneously intensive therapy: infusions of isotonic sodium chloride solution, glucose solutions, plasma, blood substitutes, as well as cardiac medications and antibiotics. In the postoperative period, constant aspiration of gastric contents is established. To stimulate peristalsis, prozerin, physostigmine, and 10-20 ml of hypertonic sodium chloride solution are administered subcutaneously.

Large doses of antibiotics are given intravenously to treat bacterial peritonitis. . Surgery is often necessary when peritonitis occurs as a result of an illness that has perforated the intestinal tract, such as a gastric or duodenal ulcer or a ruptured appendix. . Intravenous fluids and food are usually needed to prevent dehydration and give the intestines a rest. . Analgesics may be used to reduce pain. . A tube passing through the nose into the intestine is attached to a suction device to remove contents from the temporarily paralyzed intestine.

Prevention

. Prompt treatment of any contagious diseases, injuries or diseases associated with the abdominal cavity is necessary. . Attention! Visit a doctor or call immediately " ambulance" if you experience severe abdominal pain that lasts more than 10 or 20 minutes and is accompanied by any other signs of peritonitis.

Peritonitis is called inflammation of the peritoneum. This condition is extremely dangerous for the body, as it disrupts the functioning of all vital important organs. Acute peritonitis requires emergency medical care, otherwise it can lead to death within a short time.

Peritonitis is caused by an infection or foreign substance (pancreatic enzymes, bile, etc.) that has entered the abdominal cavity. The main reason why the infection penetrates to the peritoneum is purulent melting of the abdominal organ, trauma to the hollow organs of the abdominal cavity, trauma, including surgical trauma, in the area of ​​the abdominal organs.

The most common infectious agents that cause peritonitis are streptococci, staphylococci, Pseudomonas aeruginosa, Escherichia coli, gonococci, pneumococci, mycobacterium tuberculosis, and anaerobic microorganisms.

The main cause of infectious peritonitis is acute purulent appendicitis, somewhat less frequently perforation of gastric and duodenal ulcers, acute purulent cholecystitis, acute pancreatitis, acute purulent inflammation pelvic organs, ruptures of the stomach, intestines, bladder as a result of injuries or advanced tumor process.

Types of peritonitis

Peritonitis can be primary or secondary.

Primary, also known as idiopathic or viral peritonitis, occurs extremely rarely, as a result of a primary infectious lesion of the abdominal organs and peritoneum. In the case of viral peritonitis, the infection penetrates the peritoneum hematogenously, or through the lymphatic vessels, and occasionally through the fallopian tubes. Viral peritonitis accounts for no more than 1% of all cases of the disease.

Depending on the reason, there are:

• Infectious peritonitis;
• Perforated peritonitis;
• Traumatic peritonitis:
• Postoperative peritonitis.

According to the nature of the inflammatory exudate:

• Serous peritonitis;
• Purulent peritonitis;
• Hemorrhagic peritonitis;
• Fibrinous peritonitis;
• Gangrenous peritonitis.

By degree of distribution:

• Local peritonitis;
• Generalized peritonitis;
• General (total) peritonitis.

By localization:

• Limited (enclosed) peritonitis;
• Diffuse peritonitis.

By traumatic factor:

Acute peritonitis has several phases of development:

• The reactive phase lasts from 12 to 24 hours;
• Toxic phase, duration from 12 to 72 hours;
• The terminal phase occurs after an interval of 24 to 72 hours from the onset of the disease and lasts several hours.

Thus, acute peritonitis can lead to death within 24 hours of the onset of the disease.

The symptoms of peritonitis in the initial, reactive phase initially coincide with the symptoms of the underlying disease, which become sharper and brighter. Typically, the onset of acute peritonitis is indicated by increased pain, spreading to the entire abdomen, the peak of pain is noted in the area of ​​the primary focus. The abdomen becomes tense and board-shaped. The symptoms of peritoneal irritation are sharply positive, the most famous of which is the Shchetkin-Blumberg symptom: when palpating the abdomen with a quick withdrawal of the hands, sharp pain occurs. The patient tries to lie on his side with his legs brought to the stomach (“fetal position”), any attempt to change the position increases the pain. Speech is quiet, moans are weak. Body temperature is increased.

Symptoms of peritonitis in the toxic stage can be misleading in that there is an apparent improvement. The pain subsides, the abdomen ceases to be tense, and the patient enters a state of lethargy or euphoria. His facial features become sharper, pallor appears, and nausea and vomiting are possible. Sometimes vomiting takes on a painful, debilitating character. Urinary excretion and intestinal motility decrease, and even when listening, the usual intestinal sounds cannot be heard (symptom of “deafening silence”). The mucous membranes of the oral cavity are dry, but fluid intake is difficult due to lethargy or vomiting. About 20% of patients die at this stage.

Symptoms of peritonitis in the terminal stage indicate a deep dysfunction of all body systems and the onset of a decompensation phase, when the body's defenses are depleted. The patient is in prostration, indifferent to what is happening, sometimes at this stage an intoxication mental disorder occurs. The face takes on an earthy tint, the eyes and cheeks become sunken (the so-called “Hippocratic mask”), and cold sweat appears. Possible vomiting of putrefactive contents of the small intestine. Shortness of breath and tachycardia develop, body temperature, previously elevated, drops. The abdomen is swollen and painful, but there is no protective muscle tension. The Shchetkin-Blumberg symptom becomes mild. About 90% of patients die at this stage.

Diagnosis of peritonitis

The diagnosis is made based on the characteristic symptoms of peritonitis and blood tests. In the blood test, a purulent-toxic shift in the leukocyte formula is observed. X-ray diagnostics and ultrasonography abdominal organs, and in doubtful cases - laparoscopy.

It must be said that the diagnosis of peritonitis should be as urgent as possible, since the condition requires urgent treatment.

Treatment of peritonitis

Treatment of peritonitis is carried out in the emergency surgery department. If you suspect acute peritonitis, you should not take food, water or painkillers, use heating pads or give enemas, the patient should maintain a supine position. The treatment of peritonitis, with the exception of rare cases (limited peritonitis, state of agony, etc.), is surgery.

Before the operation, preparations are carried out aimed at at least partially stabilizing the patient’s condition. Preparation consists of replenishing fluid balance, removing painful shock and normalization of blood pressure.

Surgical intervention for the treatment of peritonitis is performed under general anesthesia. During the operation, the primary infectious focus is eliminated, the inflammatory effusion is removed, the abdominal cavity is washed with antiseptics and drainage is installed. Then the intestinal obstruction that developed as a result of sepsis is restored, and intestinal compression is eliminated. After the operation, it is time for drug treatment of peritonitis, for which active antibacterial therapy is used, as well as therapy aimed at maintaining the vital functions of the body.

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Peritonitis is an inflammatory, bacterial, aseptic process of a local or diffuse nature that develops in the abdominal cavity. This process is a severe complication of destructive and inflammatory diseases of the peritoneal organs.

Peritonitis occurs when the serous lining of the abdominal cavity, also called the peritoneum, becomes inflamed. This inflammatory process belongs to the category of dangerous surgical conditions under common name"acute belly"

The development of the disease is characterized by intense pain in the abdominal area, tension in the muscle tissue of the abdominal cavity, and a rapid deterioration in the patient’s condition and well-being.

Peritonitis of the abdominal cavity is a common disease with a high mortality rate. Today, the mortality rate from inflammation of the peritoneum is 15–20%, although until recently this figure was much higher and varied between 60–72%.

Causes of the disease

The causes of peritonitis can be very diverse and primarily depend on the type and characteristics of the inflammatory process, which can be primary or secondary.

The primary type of peritonitis develops as an independent disease as a result of bacterial infection and pathogens entering the abdominal cavity through the bloodstream and lymphatic system. It is extremely rare - no more often than 2% of all cases of the disease.

Bacteriological infections that can cause the development of inflammation of the peritoneum include both gram-positive and gram-negative bacteria, among which are Enterobacter, Pseudomonas aeruginosa, Proteus, coli, streptococci, staphylococci.

In some cases, the occurrence of an inflammatory process may be associated with the penetration of specific microflora into the abdominal cavity - gonococci, pneumococci, mycobacterium tuberculosis and hemolytic streptococci.

Secondary type - the inflammatory process develops against the background of damage to the abdominal organs or gastroenterological diseases.

We can identify the main factors that can provoke the development of inflammation of the abdominal cavity:

• Surgical intervention on the peritoneal organs.
• Damage to internal organs located in the abdominal cavity, violation of their integrity.
• Various internal processes of an inflammatory nature - salpingitis, appendicitis, cholecystitis. It has been established that in more than 50% of cases the main cause is secondary inflammation.
• Inflammations that do not have a direct connection with the abdominal cavity - phlegmon and purulent processes.
• In women, peritoneal peritonitis can be triggered by inflammatory processes in the pelvic organs.

In the vast majority of cases, peritonitis acts as a complication of various injuries and diseases of a destructive-inflammatory nature - appendicitis, pyosalpinx, perforated ulcer stomach or duodenum, pancreatitis, pancreatic necrosis, intestinal obstruction, rupture of an ovarian cyst.

Types of peritonitis

Peritonitis is classified according to several parameters, such as the etiology of the disease and the extent of inflammation. Depending on the characteristics of the course, inflammation can be acute or chronic. Chronic peritonitis often develops against the background of a systemic infection of the body - tuberculosis, syphilis. Acute form peritonitis is characterized by rapid development and rapid manifestation of clinical symptoms.

Depending on the characteristics of the etiology, the inflammatory process in the peritoneum can be bacterial, developing as a result of the penetration of infection into the abdominal cavity, as well as abacterial, that is, provoked by aggressive agents of non-infectious origin. Such non-infectious pathogens include blood, bile, gastric juice, pancreatic juice, and urine.

Depending on the area and extent of the lesion, the disease is divided into several forms:

1. Local - exclusively one anatomical element of the peritoneum is involved in the inflammatory process.
2. Widespread or diffuse - inflammation spreads to several parts of the abdominal cavity.
3. Total type - characterized by extensive damage to all parts of the peritoneal cavity.

Due to the occurrence:

• Traumatic type of peritonitis.
• Infectious.
• Postoperative.
• Probodny.

Depending on the presence of exudate, inflammation of the peritoneum is divided into dry and exudative (wet) type of peritonitis.

Depending on the characteristics and nature of the exudate:

• Purulent.
• Serous.
• Gall.
• Fecal.
• Fibrinous.
• Hemorrhagic.

Based on the type of infectious agent, peritonitis is divided into tuberculous, streptococcal, gonococcal, and clostridial.

Depending on the severity and severity of pathogenetic changes, several stages of the inflammatory process are distinguished, each of which has its own characteristics and symptoms.

The reactive stage of peritonitis is the initial stage of the disease, the symptoms of which appear during the first day after the infection enters the abdominal cavity. The reactive stage is characterized by swelling of the peritoneum, the appearance of exudate and pronounced local reactions.

Toxic stage – occurs within 48–72 hours from the moment of injury. This stage is characterized by intensive development of signs of intoxication.

Terminal stage - characterized by a general deterioration of the body and a weakening of the vital functions of the body, the functioning of the protective-compensatory system is reduced to a minimum.

Symptoms and signs

The main signs of peritonitis can be divided into general and local. Local signs represent the body's response to irritation of the abdominal cavity with exudative fluid, bile or blood. The main local symptoms of peritonitis include severe tension in the anterior wall of the abdominal cavity, pain in the abdominal area, and irritation of the peritoneal cavity, identified during a medical examination.

First and most pronounced symptom the initial stage of inflammation of the peritoneum is pain, which may have varying degrees expressiveness and intensity. The most severe is the pain syndrome that accompanies peritonitis with perforation of internal organs located in the abdominal cavity. Such pain is described in the medical literature as “dagger-like” - sharp, sharp and piercing.

At the initial stage of peritonitis, painful sensations are localized exclusively around the immediate lesion. But after some time, the pain becomes diffuse, generalized, which is associated with the spread of inflamed exudate throughout the internal organs.

In some cases, pain may move and be localized in another area of ​​the abdominal cavity. This does not mean that the inflammatory process has decreased or stopped - this is how damage to another internal organ manifests itself. Sometimes the pain may disappear completely - this is enough danger sign, which may indicate the accumulation of excessive amounts of inflammatory fluid.

Characteristic general symptoms of peritonitis are severe nausea, heartburn, vomiting mixed with gastric contents and bile. Vomiting accompanies the entire period of the disease, for more than late stages The disease causes so-called “fecal” vomiting mixed with intestinal contents.

As a result of general intoxication of the body, intestinal obstruction, which can be expressed in the form of flatulence, delayed passage of gas or stool disorders.

Other common symptoms of peritonitis:

• Increased body temperature, chills.
• Significant deterioration in general health – weakness, apathy.
• Rapid jumps in blood pressure up to 130–140 beats per minute.
• The appearance of a person changes radically - facial features become more pointed, the skin turns pale, cold sweat occurs, the facial expression becomes twisted and suffering.
• A person cannot sleep fully, he is tormented by sleep disorders - insomnia or constant drowsiness. In addition, the patient cannot lie in bed due to acute pain, he tries to take the most comfortable position for himself - most often on his side, with his legs pulled up to his stomach.
• In advanced stages of peritonitis, a person experiences confusion and cannot normally and adequately assess what is happening.

With the development of the most complex, terminal stage of peritonitis, the patient’s condition becomes extremely serious: the skin and mucous membranes acquire an unhealthy pale, bluish or yellowish tint, the mucous membrane of the tongue is overdried, and a thick dark coating appears on its surface. The psycho-emotional mood is unstable, apathy is quickly replaced by a state of euphoria.

The symptoms of the disease differ significantly depending on the stage of the inflammatory process. Each of them has its own characteristics and characteristics.

The reactive stage, which is the initial stage, is accompanied by the appearance of spasms and pain in the peritoneum, tension in the anterior abdominal wall, fever, weakness and apathy.

Toxic stage - manifested by some improvement in the patient’s condition, which, however, is imaginary. This period is characterized by intense intoxication of the body, which is expressed in severe nausea and debilitating vomiting. Appearance a person’s appearance also leaves much to be desired – pale skin, dark circles under the eyes, sunken cheeks. As shown medical statistics, approximately 20% of all cases of peritonitis end in death at the toxic stage.

The terminal stage is considered the most severe and dangerous not only for health, but also for human life. At this stage, the level of the body’s defenses decreases to a minimum level, and the person’s well-being becomes much worse. The abdomen swells sharply, the slightest touch to its surface causes an intense attack of pain.

At the terminal stage of peritonitis, the patient experiences severe swelling internal organs, as a result of which the excretion of urine from the body is impaired, shortness of breath, increased heartbeat, and confused consciousness appear. As medical practice shows, even after surgery, only every tenth patient manages to survive.

The symptoms of chronic peritonitis look somewhat different - they are not as pronounced as the signs of acute inflammation and are more “blurred”. The patient is not bothered by debilitating vomiting, nausea, stool disorders or painful spasms in the abdominal area. And therefore for a long time chronic form The disease may proceed completely unnoticeably to a person.

At the same time, long-term intoxication of the body cannot be completely asymptomatic; most often, the presence of chronic peritonitis can be determined by the following signs:

• Body weight rapidly decreases, while the diet remains the same.
• A person has an elevated body temperature for a long time.
• Constipation occurs from time to time.
• Increased body sweating.
• Periodic pain in the abdominal area.

As the disease progresses, symptoms become more severe and frequent.

Diagnosis of peritonitis

Timely diagnosis of peritonitis is the key to successful and effective treatment. To carry out diagnosis, a clinical blood test is required, on the basis of which the level of leukocytosis is examined.

Ultrasound and X-ray examination abdominal organs, during which specialists study the presence of exudate in the abdomen - accumulated inflammatory fluid.

One of diagnostic measures is to conduct vaginal and rectal examination, which allows you to identify pain and tension in the vaginal vault and rectal wall. This indicates inflammation of the peritoneum and the negative impact of accumulated exudate.

In order to eliminate any doubts in diagnosis, a puncture is taken from the peritoneum, thanks to which the nature of its contents can be examined. In some cases, laparoscopy is recommended. This is a painless, non-invasive diagnostic method, which is carried out using special device– laparoscope. As a result of laparoscopy, the doctor receives a complete clinical picture of the disease and is able to make the correct diagnosis.

Treatment

To date, the only effective treatment for abdominal peritonitis remains surgical treatment. Despite the progress of modern medicine, the mortality rate remains quite high. It is for this reason that maximum attention should be paid to the treatment of peritonitis. It is considered the most effective complex method treatment that combines surgical and drug therapy.

Simultaneously with the surgical intervention, drug treatment is carried out, the main goal of which is to eliminate the infection, as well as prevent the development of possible complications.

The most commonly prescribed medications are:

1. Broad-spectrum antibiotics - Ampicillin, Methicillin, Benzylpenicillin, Gentamicin, Oletetrin, Kanamycin.
2. Infusion solutions - such drugs are used to restore lost fluid and prevent possible dehydration of the body. Such solutions include Perftoran and Refortan.
3. Sorbents and detoxification drugs, the action of which is aimed at preventing toxic shock, removing toxins and waste from the body. The most commonly used solution is calcium chloride 10%.
4. To eliminate problems with urine excretion from the body, diuretics are used.
5. If peritonitis of the peritoneum is accompanied by an increase in body temperature, antipyretic drugs are prescribed.

Antiemetic drugs, such as Metoclopramide, are often used to eliminate vomiting and nausea. If tuberculosis-type peritonitis has been diagnosed, treatment is carried out with anti-tuberculosis drugs - Trichopolum, Gentomycin, Lincomycin.

The main objective of surgical treatment is to eliminate the root cause that provoked the inflammatory process of the peritoneum, as well as to treat peritonitis. Preoperative preparation consists of complete cleansing of the gastrointestinal tract of contents, intravenous administration of the necessary medications, as well as anesthesia.

Surgery is performed by laparotomy, that is, by direct penetration into the abdominal cavity. After this, the surgeon removes the source of inflammation, as well as complete sanitation of the peritoneal cavity. This means that if the cause of peritonitis is an organ, after removal of which a complete cure is possible, resection of this organ is performed. More often we're talking about about the gallbladder or appendix.

The abdominal cavity is washed using special antiseptic solutions, which helps to effectively eliminate the infection and reduce the amount of exudate released. The next stage is intestinal decompression. This is the name of the procedure for removing accumulated gases and liquids from the intestines. To do this, a thin probe is inserted through the rectum or oral cavity, through which fluid is suctioned from the abdominal cavity.

Drainage of the peritoneum is carried out using special hollow drainage tubes, which are inserted in several places - under the liver, on both sides of the diaphragm and in the pelvic area. The final stage of surgery is suturing. Sutures can be placed with or without drainage, depending on the severity of the disease.

In simple forms of peritonitis, a continuous suture is applied, without drainage tubes. In case of more severe purulent forms inflammation, suturing is carried out simultaneously with the introduction of drainage tubes, through which exudate is removed.

Treatment of peritonitis is carried out only in inpatient conditions, self-treatment not allowed. It is important to remember that no more than 72 hours pass from the moment of damage to the peritoneum until the development of the most severe, terminal stage. Therefore, any delay in applying for a qualified medical assistance and the operation is fraught with the most adverse consequences for human health and life.