home Audience 4 Peritonitis: symptoms in adults, treatment. Surgical complications. Peritonitis. Symptoms of the disease

Peritonitis: symptoms in adults, treatment. Surgical complications. Peritonitis. Symptoms of the disease

Peritonitis is characterized by severe general symptoms, including endogenous intoxication and multiple organ failure. Mortality with peritonitis has always remained one of the highest and reached 55-90% in postoperative surgical peritonitis. Despite the fact that such a formidable complication as peritonitis after surgery caesarean section, is currently relatively rare (0.2-0.8%), mortality in this form of purulent-septic diseases remains high and reaches 26-35%.

Peritonitis is an inflammation of the peritoneum, accompanied by the development of severe intoxication of the body. Peritonitis refers to the diffuse spread of inflammation.

Local inflammation is defined as abdominal abscesses (limited peritonitis). Peritonitis is secondary process complicating the course of the underlying disease. Idiopathic (primary) peritonitis, when the source has not been identified in the last 20 years, does not occur at all and is excluded from the classification.

With diffuse peritonitis, according to the distribution in the peritoneum, they are distinguished: local peritonitis, when part or one anatomical area of the cavity is affected; widespread peritonitis, when the process affects several areas, diffuse (general), affecting the entire peritoneum. The severity of intoxication is explained by the enormous length of the peritoneum - almost 10 square meters. m with high exudation by the visceral layer and resorption by the parietal layer. Therefore, toxins quickly and large quantities, enter the blood.

According to etiology, peritonitis is divided into bacterial (infectious), developing when inflammatory diseases internal organs or perforations of hollow organs, as well as injuries; and aseptic peritonitis, when the inflammatory process of the peritoneum is caused or irritated chemical substances, or biological fluids - bile, urine, blood. Exudate can be: serous, hemorrhagic, fibrinous, purulent, putrefactive. The clinical course is acute, subacute and chronic. In acute peritonitis, reactive, toxic and terminal stages of the course are distinguished.

Belly - that’s what the common people called one of the important parts bodies. Usually a person does not pay attention to the state of his belly. However, it is this department that performs one of the important functions– bactericidal. The peritoneum has a fairly simple structure - two petals that are not interrupted, pass into one another, create a sealed space and fix the internal organs. But if for some reason, then this leads to undesirable consequences..

What is peritonitis?

No organ is deprived of the possibility of being inflamed. Most often, the infection even penetrates into areas that a person does not know about. What is peritonitis? This is an inflammation of the serous lining of the abdominal cavity, which is called the peritoneum. There is another name for this disease - “”.

Kinds

There are several types of peritonitis, according to different classifications:

Most main reason Peritoneal peritonitis is an infection that rarely penetrates through the blood or lymph (in 2% of cases), and most often occurs due to a violation of the integrity of the pelvic organs or abdominal cavity. Often the disease occurs as secondary disease, that is, against the background of some damage that is already observed in the patient. The main factors provoking peritoneal peritonitis are:

– the cause of 50% of all peritonitis.
Perforation duodenum or stomach ulcers are the cause of 15% of all peritonitis.
Violations biliary tract or intestines - the cause of 10% of all cases of peritonitis. What diseases are identified here as provocateurs of peritoneal inflammation? Intestinal obstruction, perforation of ulcers in colitis, enterocolitis, cholelithiasis, diverticulitis, perforation of ulcers in Crohn's disease.
Inflammation of the female reproductive system is the cause of 10% of all peritonitis. What diseases cause inflammation of the peritoneum? Salpingitis, rupture of an ovarian cyst or fallopian tube, pyosalpinx.
Abdominal injuries.

This also includes isolated cases associated with pancreatic diseases, Bladder and spleen.

Separately, aseptic peritonitis is distinguished, which does not occur due to infection in the abdominal cavity, but due to the aggressive effects of blood, urine, pancreatic juice. This type The reasons are called toxic-chemical, since the liquid has a toxic effect on the abdominal cavity. Everything would be fine if, after a few hours, bacteria did not attach to the affected area and turn aseptic peritonitis into bacterial.

Separate view aseptic peritonitis is barium when the substance leaves the gastrointestinal tract and fills the abdominal cavity. Such situations happen rarely, but the mortality rate is more than 50%.

Symptoms and signs

Signs of inflammation of the peritoneum are divided into local and general. Local symptoms include the following:

Pain is the most main symptom any peritonitis, which is at first localized (in the affected area), and then becomes diffuse;
Peritoneal irritation;
Tension of the abdominal muscles occurs involuntarily as a reflex reaction of the body. Can be local or general.

TO general symptoms inflammation of the peritoneum includes the following:

The symptoms of tuberculous peritonitis are similar to the symptoms of ordinary tuberculosis in respiratory diseases:

Weight loss;
Intermittent cough;
Fever that doesn't go away;
Increased sweating.

In practice, doctors distinguish symptoms according to the stages of the disease:

Reactive (initial):
- Symptoms begin with local signs and develops to general in one or several days.
- The patient lies on his back, legs bent to his stomach.
- Temperature and rapid heartbeat occur.
- Arises vomiting reflex and nausea.
- The tongue becomes dry and coated.
- Shallow breathing appears.
- The more acute the disease, the more confused the consciousness becomes.
- Signs of the Shchetkin-Blumberg symptom appear.
Toxic:

Manifests general symptoms with general intoxication. Develops up to 3 days after the onset of the disease.
Water-electrolyte metabolism and metabolism are disrupted.
Breathing becomes frequent, shallow, intermittent.
I suffer from vomiting, in which the waste material has a foul odor.
Dehydration and thirst occur, which cannot be eliminated by drinking. Over time, the amount of urine becomes scanty.
The tongue is covered with a brown coating.
Convulsions or arrhythmia appear due to the loss of salts by the body.
Muscle tension leads to bloating.

Terminal:

Occurs on the 4th day after the onset of the disease.
There is dehydration and a precomatous state.
The face changes: the features become pointed, the eyes and cheeks recede, the skin takes on an earthy color, the skin is so dry and tight that the temples are hollow.
Abdominal pain occurs on palpation.
The patient usually lies motionless.
His consciousness is confused.
The belly is very distended.
Breathing becomes intermittent and the pulse becomes thready.

The chronic form of peritonitis, as with other inflammatory diseases (for example, colitis or gastritis), is asymptomatic. Has the following signs:

Increased sweating;
Anorexia;
Temporary constipation;
Low temperature;
Temporary abdominal pain.

Peritonitis in a child

It is peritonitis that can become a serious cause for concern for parents if it appears in a child. This disease is quite rare, but if it does appear, it brings many problems. In 70% of cases it leads to death, so you should act immediately and seek help. medical assistance. Fortunately, modern medicine can reduce mortality rates by up to 20%. The most common type is tuberculous peritonitis.

Since children often get sick from various bacterial diseases, then the risk of inflammation of the peritoneum is high. The infection penetrates through the blood into weak areas of the body and begins to multiply. Therefore, here parents should not wait for the child to recover on his own, but start treating him in the early stages so that sepsis does not develop.

Peritonitis in adults

In adults there are different kinds peritonitis. If we talk about the tuberculosis form, it often occurs in women due to the transfer of mycobacteria from the genitals. The disease occurs 9 times more often in women than in men.

Diagnostics

Diagnosis of inflammation of the peritoneum begins with asking the patient about what symptoms are bothering him and what he was previously ill with or is currently ill with. By general examination(measurements of pulse, respiration and pressure) conclusions are drawn. To clarify the diagnosis, additional procedures are performed:

Treatment

Treatment of peritonitis is divided into hospital and out-of-hospital forms. Because the " acute stomach“has a high mortality rate, the disease begins its treatment in hospital form. The secondary nature forces us to first eliminate the root cause: remove the purulent appendix gallbladder, suturing a perforated ulcer. That is, it is carried out surgery, after which they begin to eliminate peritonitis.

How to treat inflammation of the peritoneum? Medicines:

Antibiotics (pecillin, aminoglycosides, macrolides).
Glucose infusion solutions.
Detoxification medications and sorbents (hemodez, 10% calcium chloride).
Diuretics (furosemide).
Antipyretics (ibuprofen, paracetamol).
Antiemetic drugs (metoclopramide).
Anticholinesterase drugs (prozerin, ubretide).
Anticoagulants (heparin).
Anabolic drugs (retabolil, insulin and glucose).

Painkillers are not prescribed because they lubricate clinical picture, which shows how the disease progresses. As for surgery, it is a mandatory procedure. Its purpose is to remove exudate, isolate the source of bacteria, resection, free the gastrointestinal tract from liquid and gases, and sanitize the peritoneum.

Is it possible to treat peritonitis at home?

Peritonitis cannot be cured at home, so the disease cannot be treated at home. Immediately at the first symptoms, hospitalization of the patient is required, since in the absence of treatment there is a high probability fatal outcome. Home care is possible only after the patient has been cured, but even here it is necessary to periodically visit a surgeon to be examined.

Diet

During the treatment period, diet becomes very important, which is divided into three stages:

Early - lasts up to 5 days - here the patient does not eat food, but everything essential microelements he is given intravenously.
The second – duration up to 3 weeks – gradual introduction of natural food: jelly and jelly, soft-boiled eggs, meat broth, juices from fruits and berries, pureed vegetables.
Far - up to full recovery working ability – more are introduced rough products gradually. Sweets and foods are still excluded fried foods, seasonings, spices and heavy food.

Lifespan

How long do people live with peritonitis? This forecast unpredictable. The mortality rate is very high, so life expectancy decreases as the disease progresses (lasts up to 6 days if untreated). If treatment is delayed, then the patient dies. Main complications of this disease are:

The only one preventative measure is a timely visit to the doctor. It is important healthy eating and cure for other infectious diseases of the body.

Peritonitis - very dangerous disease, this is inflammation inner wall abdominal cavity.

As a rule, the disease requires urgent surgical intervention. We will help you understand the causes of the disease.

Why does it occur

This disease occurs due to severe intoxication of the body, when some internal organs cannot fully cope with their work.

Connective tissue protects all internal organs of the abdominal cavity, but when harmful microorganisms or chemicals fall on its surface, substances are released that stop this process.

Exposure to a small amount of irritants is not dangerous, but if this happens constantly and large quantities, then peritonitis occurs. This is a very dangerous disease that can even lead to the death of the patient. It is important to seek help from a doctor in a timely manner.

The cause of inflammation of the peritoneum can be bacteria accumulated in it, various diseases gastrointestinal tract and fluid entering the peritoneal cavity.

Peritonitis can also begin as a result of injuries in which wounds form in the internal organs. It may be a consequence of an unprofessionally performed operation, or a complication of gynecological diseases.

Different types of disease

Peritonitis can be: primary, secondary and tertiary. Primary is caused by the presence of infection in the body. And the abdominal cavity remains intact and unharmed.

Primary peritonitis comes in several categories:

spontaneous childish;
spontaneous adult;
in people with active tuberculosis.

With secondary inflammation, the abdominal cavity is either slightly damaged or a complete rupture of the peritoneal tissue occurs. There is a violation of the integrity of organs.

Typically, a disease of this nature is the result of either an abdominal injury or an unsuccessful operation.

Tertiary peritonitis, fortunately, is rare. In essence, it represents a relapse of peritonitis, that is, it is peritonitis that develops after peritonitis. With this disease, very severe intoxication of the body occurs.

Almost all internal organs stop working. A prerequisite for its occurrence may be severe decline immunity. Treatment this type peritonitis does not respond and the patient always dies.

Symptoms and signs of the disease in adults

Depending on what caused the disease, its initial symptoms may vary.

But still, there are several symptoms that are characteristic of all types of the disease. Experts will highlight three main stages of disease development.

The appearance of a reactive stage in a person

Symptoms of this stage appear on the first day. It is usually accompanied by severe pain in the area where inflammation develops. Depending on which organ was affected, the pain may be of a different nature.

For example, if peritonitis develops against the background of a stomach ulcer, then you will feel sharp pain in the epigastric region. If the cause is a ruptured appendix, you will feel pain in the area under your right lung. Over time, the pain will spread to the entire abdominal area.

It also happens that after the first outbreak painful sensations disappear or become less noticeable. But everything resumes after a while.

A person suffering from peritonitis is very easy to identify by his face. It becomes pale and acquires an earthy tint. During moments of pain, the face becomes covered with sweat. Dehydration begins and facial features become sharper and sharper.

There are other symptoms that are noticeable to others. So the patient tries to take a more comfortable position in order to somehow relieve the pain. In most cases, this is a pose lying on your side with your legs tucked towards you.

This is due to the fact that he tries in every possible way to protect the stomach from any tension. When examined, such a patient will have a plank abdomen - very tense abdominal muscles. The body begins to dehydrate.

Development of a toxic stage in the body

It starts on the second or third day. Symptoms of peritonitis become less pronounced, while general state getting worse.

Due to dehydration, the brain activity. Body temperature rises to 40-42 degrees, pulse quickens.

Terminal stage or irreversible

If you allow the disease to develop to this stage, then most likely it will end in death. Dehydration has reached critical level. The functioning of the lungs is disrupted, the pulse begins to disappear.

Features of pathology in women

In some cases, peritonitis may develop against the background of an unsuccessful operation. In 5-7%, this disease develops in women after a poor-quality cesarean section. With this cause of the disease, the probability of death is very high.

A complication of the operation may involve suppuration of the suture, acute inflammation appendages, soft tissue abscess and endometritis. Against the background of all this, inflammation of the peritoneum develops.

You are at risk of developing peritonitis if you suffer from gynecological diseases, including chronic and acquired during pregnancy. Such diseases include vaginosis with colpitis.

Women under 16 and over 35 years of age are at risk. Peritonitis and sepsis can also be the result of frequent vaginal examinations. It can develop during unsuccessful or prolonged labor.

Extensive type of peritonitis

Acute or extensive peritonitis is secondary in almost all cases. That is, it develops against the background of already eliminated peritonitis. It can be a complication of an incorrectly performed operation.

Identified factors for the occurrence of this variety

The cause of extensive inflammation is the penetration of microorganisms into the peritoneal cavity. In almost all cases it is caused by advanced stage appendicitis.

The development of peritonitis directly depends on the development of appendicitis. Other gastrointestinal diseases may also be the cause. This acute cholecystitis, pancreatitis, various ulcers, intestinal damage and even gynecological diseases.

Diagnosed signs in patients

One of initial signs peritonitis is constant pain in the abdomen, which intensifies over time. Gradually, from the source of pain, it spreads to the entire peritoneum. The patient experiences vomiting, during which the abdominal pain becomes even worse.

Body temperature rapidly rises to 39 degrees. At the slightest movement the pain becomes unbearable.

The patient is thirsty. Drinking water provokes vomiting. Bowel function stops. Abdominal bloating occurs, feces and gases cease to pass away. Shortness of breath appears, the person becomes very pale.

Video

Effective treatment tactics

There is no drug treatment for peritonitis. The disease can only be treated through surgery. The operation is performed as quickly as possible and requires special preparation.

The doctor opens the abdominal cavity, eliminates the cause and sutures the affected organ.

Internal organs and peritoneum are treated with an antiseptic and saline solution. If the radius of the lesion is large, the wound is not completely sutured and an additional examination is carried out on the second or third day.

With this disease, the main thing is not to waste time. The sooner you go to the hospital, the better. If the disease reaches only the reactive stage, then the patient's general condition will not be so affected.

On toxic stage it will be more difficult. If the disease is allowed to develop until terminal stage, then it is no longer possible to save the patient.

Postoperative prognosis for patients

After the operation, problems in the functioning of the stomach and intestines may occur. The patient may feel severe pain at the surgical site, and improper care a complication begins in which suppuration forms.

When the cause of peritonitis has been eliminated, the patient needs specific care.

He must be constantly monitored. The person who is monitoring the patient should assess the respiratory rate every hour, take measurements of pulse, urine output and central pressure in the veins.

Some medication support and special therapy are needed. A colloidal or crystalloid solution is injected intravenously, which is preheated.

Ventilation is provided for three days. This way, all organs and tissues receive enough oxygen to function properly. The body is supported with glucose and the intestines are started.

To prevent pain, narcotic drugs are used, which are combined with anti-inflammatory drugs. For example, the patient may be prescribed morphine, fentanyl, ketorolac and others.

Relapses after a properly performed operation are rare. To completely protect yourself from them, you need to adhere to special food and way of life.

Recovery after surgery

The recovery period when peritonitis was operated on is quite long. After the operation, corrective therapy begins. During this procedure, special solutions are introduced into the body.

The goal of therapy is to replenish water and electrolyte losses. On the second day of recovery, the dose of solutions is reduced, and the body begins to receive nutrients(glucose). Energy value nutrition should be from 2000 to 2500 kcal per day.

The amount of protein that enters the body should be from 40 to 100 grams. These calculations were carried out for a patient weighing about 50-60 kg.

The next mandatory stage of recovery is to restart the lungs. After surgery, artificial ventilation is mandatory. It lasts from one day to whole week. It all depends on the complexity of the operation performed and the condition of the patient.

Next in line is the elimination of cardiac and vascular insufficiency. For her successful implementation Glycosides, adrenaline and other substances that stimulate contraction of the heart muscles are introduced into the body.

The main goal of all manipulations is to improve blood flow throughout the body and stabilize diuresis.

To avoid painful shock in the first days after surgery, the patient is given high doses narcotic painkillers until the process is underway artificial ventilation lungs and restoration of circulating blood volume.

When these indicators are normal, narcotic analgesics are replaced with epidural anesthesia. Those patients who have suffered the toxic or terminal phase of peritonitis are susceptible to developing disseminated intravascular coagulation syndrome. And this requires additional treatment.

It is very important to restore the amount of potassium and sodium in the body. Thanks to them, gastrointestinal motility is normalized. The small intestine is intubated to restore its motility.

After peritonitis, the whole body is still very weak. The stomach is not overloaded so that it can function normally.

The following should be excluded from the diet:

fat;
spicy;
fried;
smoked;
pickled food.

Food should not irritate the walls of the stomach. Alcohol and carbonated drinks are strictly prohibited. Tobacco products also prohibited.

Drinks such as tea and coffee can be consumed in very small quantities. Caffeine may harm the patient.

Eat more natural products. Focus on vegetables and fruits with high content fiber, calcium and other beneficial substances.

Can be used:

The food cannot be eaten raw. It is better to boil or steam. After some time, the menu can be diversified.

It is allowed to add lean chicken or turkey, eggs, cereals with water and without oil, vegetable soups in rabbit broth, lean fish. It is better to boil the fish.

You can drink low-fat milk and dairy products. Eat honey and jam in small quantities. To support your body, take special vitamin complexes. They must be prescribed directly by a doctor.

Food should be taken in small quantities and at the same time. All this is done to avoid overloading the stomach and retaining food in the body. This diet should be followed after surgery.

Possible consequences of pathology

There are two types of consequences of peritonitis. The first is the consequences. acute peritonitis. They are very serious and even deadly for you.

These consequences include:

All of them require immediate resuscitation.

The second is postoperative. It is less dangerous and usually does not require further surgery.

Such consequences include adhesions, hernias, and intestinal dysfunction. Women may have difficulty conceiving a child.

Peritonitis of the abdominal cavity

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The peritoneum is the serous membrane that lines the inner surface abdominal cavity and covers abdominal organs. Sometimes it becomes inflamed - and the doctor diagnoses “peritonitis”. Symptoms do not always allow us to draw conclusions about the essence of the disease at home, however, at the slightest suspicion of peritonitis, you should immediately call an ambulance. Because this diagnosis has a mortality rate of more than 10 percent. professional treatment. Without treatment, almost everyone dies.

Don't play dangerous games" traditional treatment"with the disease "peritonitis". Symptoms at the beginning of the development of inflammation are similar to normal food poisoning: characterized by nausea and very severe vomiting, which are combined with obtuse or aching pain in the abdomen, which becomes especially noticeable when touched. However, soon the pain becomes incessant and unbearable, intensifying with any movement. The patient may have chills and fever. It seems to him that fluid is flowing in his stomach. An uncontrollable thirst also often occurs. Often the patient is unable to urinate or produces much less fluid than usual. It happens that the process of bowel movement becomes almost impossible for such a patient.

Why does peritonitis occur? The symptoms that we have listed cannot in themselves explain the occurrence of the disease. Let's talk about the most common reasons peritonitis.

Firstly, these are liver diseases accompanied by the process of cirrhosis. With this disease, fluid accumulates in the abdomen, into which pathogens can penetrate. The inflammation caused by them is peritonitis. Signs of the disease are combined with classic symptoms of liver damage, for example, yellow sclera.

Secondly, during the process when a catheter is inserted, infection may occur. Therefore, such manipulations can only be carried out in clinics that inspire trust.

Thirdly, which can be so threateningly provoked by other very serious conditions. Such as a ruptured appendix, pancreatitis, perforation of the wall of the stomach, intestines or gall bladder.

Peritonitis, the treatment of which can only be entrusted to a doctor, is always a disease that directly threatens the patient’s life. Therefore, with the main symptom - excruciating pain with any movement, spread throughout the abdomen, you need to immediately call ambulance, and not try to take the sick person to the clinic. After all, a therapist will not be able to help. The disease can quickly provoke sepsis. And this condition is very difficult to treat.

If a patient's blood pressure drops sharply, this may be a sign of sepsis. Be sure to report this symptom the operator who takes the call to the ambulance, the fact is that in this case a resuscitation team may be needed, and not a regular one.

After the sick person is admitted to the hospital, he will immediately be prescribed intravenous therapy with the most powerful antibiotics or antifungal agents. In order to accurately know the pathogen, the doctor will take a puncture of fluid in the peritoneum. If the patient develops failure of any of the organs, then maintenance therapy for one or another organ will be urgently started. Very often required surgical methods treatment, especially if peritonitis is caused by a ruptured appendix or perforation of the wall of the stomach, intestines or gallbladder. In this case, the surgeon will remove the infected tissue and also remove the particularly affected part of the peritoneum. Of course, in this situation it will not be possible to get away with it. Most likely, the whole stomach will be slashed. And after the operation it will be installed drainage system, which is also very unpleasant. Therefore, we must try not to lead to peritonitis, and if it is suspected, immediately seek help.

Peritonitis, the symptoms of which we have discussed, can be prevented by monitoring the condition of your internal organs, for example, by not allowing the ulcer to become perforated. So undergo regular medical examinations and take timely measures to prevent diseases. Then you won’t have to suspect peritonitis and urgently call an ambulance.

Peritonitis is a limited or diffuse (widespread) inflammation of the serous membrane of the abdominal cavity (peritoneum), that is, the tissue that lines it from the inside and surrounds the organs located in it, blood vessels and nerve trunks. This condition is a consequence of the complicated course of various inflammatory and destructive diseases of organs.

In this article we will introduce you to the causes, symptoms, methods of diagnosis and treatment of peritonitis in adults. You will also receive information about the prognosis of this life-threatening condition.

Fatalities from inflammation of the peritoneum can reach significant values - according to statistics, in gastroenterological diseases, death from such a complication occurs in 20-30% of patients, and with serious illnesses this figure reaches 40-50%. We may recall that it was traumatic peritonitis after an injury to the abdominal cavity that caused the death of A. S. Pushkin.

A little anatomy

The peritoneum (in the image - peritoneum) limits the abdominal cavity and covers the organs located in it.

The human peritoneum consists of 2 layers (layers) passing into each other:

visceral - external, covering the muscles and bone joints that form the abdominal cavity;
parietal - lining the internal organs.

The tissue that forms the peritoneum is semi-permeable. She is involved in different processes and how the membrane performs many functions:

absorbs exudate released during the lysis of microorganisms or during necrotic processes in tissues;
highlights serous fluid, necessary for “lubricating” organs and tissues;
protects tissues from microbial and mechanical damage and etc.

The most significant protective property this tissue of the human body is its ability to stop inflammatory processes arising in the abdominal cavity. This property is ensured by the formation of adhesions that limit inflammation, as well as by immune mechanisms that are triggered in its walls during such processes.

Causes

The root cause inflammatory reaction in the tissues of the abdominal cavity, which leads to peritonitis, in most cases becomes bacterial infection(caused by microflora found in digestive tract). The following gram-negative and gram-positive microorganisms can provoke this complication:

In the vast majority of cases - according to various statistical data, 60-80% - inflammation of the peritoneum is caused not by one, but by an association of microbes. More often like this pathological process provoked coli or staphylococci. In more in rare cases The development of peritonitis is caused by pathogens such as pneumococcus, Koch's bacillus (), and hemolytic streptococcus.

Considering the above-described facts about the variability of possible pathogens of peritonitis, when prescribing treatment, the doctor must wait for the results of a sensitivity test pathogenic microflora to antibiotics.

Types of peritonitis

Depending on the etiological factor, there are the following types peritonitis:

idiopathic (or primary) - occurs when pathogenic microorganisms along with the flow of lymph, blood or fallopian tubes for diseases such as tuberculosis of the genitourinary organs;
secondary - develop as a result of injuries or inflammatory-destructive diseases of organs and are usually detected in perforated, gangrenous or phlegmonous, or duodenal intestines, ruptures of ovarian cysts, pancreatic necrosis, phlegmonous-gangrenous and other pathologies.

Depending on the microbial factor, peritonitis is:

bacterial – provoked by inflammation caused by microorganisms;
aseptic - caused by substances that are aggressive towards the peritoneum and provoke inflammation.

IN clinical practice surgeons secondary peritonitis occur more often than idiopathic ones, which occur in only 1-1.5% of patients.

IN separate group Traumatic peritonitis is distinguished:

arising as a result of closed or open injuries, causing damage to the abdominal organs;
arising as a result of carried out surgical interventions, accompanied by anastomotic failure, suture defects, accidental mechanical trauma to the peritoneum and the development of hemoperitoneum (blood accumulation).

Special types of peritonitis include the following:

Depending on the nature of the fluid accumulating in the abdominal cavity, the following types of peritonitis are distinguished:

serous;
fibrinous;
purulent;
hemorrhagic.

The nature of the peritoneal lesion may be as follows:

limited - an abscess or infiltrate occurs on the peritoneum;
unlimited – the area of inflammation does not have clear boundaries and is diffuse.

The prevalence of peritoneal lesions may be as follows:

local - only one anatomical zone of the peritoneum is affected;
common – inflamed from 2 to 5 zones;
total (or general) – 6 or more zones are affected.

By clinical course in most cases, peritonitis is acute. However, sometimes the inflammation takes a protracted course, in such situations the pathological process is considered chronic.

The above characteristics of peritonitis are difficult to remember by people who do not have medical education Therefore, in practice, the more simplified formulation “acute” is often used. The remaining classifications are usually omitted and used only for maintaining medical records.

Stages of acute peritonitis

The development of peritonitis is divided into the following stages:

early – lasts 12 hours;
late – 3-5 days;
final – 6-21 days.

Depending on the severity of inflammation, the following stages are distinguished:

reactive - a hyperergic reaction that occurs in response to irritation of the peritoneal tissue and is manifested to a greater extent by local rather than general symptoms;
toxic – expressed in an increase in signs of intoxication of the body in response to inflammation;
terminal – manifested by signs of exhaustion of the body and is accompanied by dysfunctions of vital functions important systems and organs.

Symptoms

On early stage peritonitis, the patient pays attention to the appearance of intermittent pain in the abdomen, the prevalence and intensity of which gradually increases.

In the reactive phase of peritonitis, abdominal pain appears, the intensity and location of which depends on the location of the main source of inflammation. At first painful sensations clearly limited to one zone and due to irritation of the nerves of the diaphragm by the accumulated purulent exudate may radiate to the supraclavicular region or shoulder. They are not constantly present and periodically become quieter or disappear completely. Then the pain gradually loses its original intensity, covers the entire abdomen, becomes constant and loses its primary precise localization.

On the background pain syndrome With peritonitis, the following typical symptoms are determined:

periodic vomiting of the contents of the stomach or intestines with inclusions of bile, followed by vomiting of feces (intestinal vomiting);
signs of paralysis intestinal obstruction in the form of bloating.

With peritonitis, even appearance patient:

pained look on the face;
adynamic;
pale skin;
cyanosis of mucous membranes;
cold sweat.

In bed, it becomes easier for the patient if he lies on his side or back, tucking his legs bent at the knees to his chest or stomach. Severe pain, signs of intoxication and purulent inflammation lead to impaired breathing (it becomes superficial), hypotension, increased temperature and increased heart rate to 120-140 beats per minute.

When the terminal phase begins, the patient's condition worsens even more. He develops the following symptoms:

confusion;
sharpening of facial features;
pallor with a icteric or bluish tint;
dry tongue with a dark coating;
upon auscultation of the abdomen, the so-called “deathly silence” is determined, which develops due to the lack of peristalsis in the digestive organs;
When palpating the abdomen, bloating and significantly less pain are detected.

Diagnostics

To diagnose peritonitis, the doctor examines the patient and listens to his complaints. Palpation of the abdomen reveals the following symptoms:

Voskresensky;
Bernstein;
Shchetkin-Blumberg;
Medel.

When tapping the front abdominal wall the doctor determines the dullness of sound that occurs due to swelling of the inflamed peritoneal tissues and effusion in the abdominal cavity. Depending on the stage of peritonitis, the following symptoms are determined by listening:

"falling drop";
“splash noise”;
"deathly silence."

When examining the vagina and rectum, the doctor can identify signs of pelvioperitonitis, which occurs when there is inflammation of the peritoneal tissue lining the pelvis.

To confirm the diagnosis, the patient undergoes the following studies:

radiography - when hollow organs break through under the dome of the diaphragm, the “sickle” symptom is determined, and with the development of intestinal obstruction, Kloiber’s cups are detected;
expanded - leukocytosis, increased ESR levels and neutrophilia are detected.

More often, diagnosing peritonitis is not difficult, but in complex clinical cases, the study can be supplemented by invasive techniques such as diagnostic laparoscopy or laparocentesis.

Treatment

After peritonitis is detected, the patient undergoes emergency surgery. Its technique depends on the root cause of the complication and is always aimed at eliminating the source of the infectious or other agent irritating the peritoneum.

During the operation, a laparotomy is always performed, which gives the surgeon the opportunity to sufficiently examine the peritoneal tissue and identify all possible sources of perforation (for example, in the intestines or stomach). To eliminate perforations, suturing is performed, which, if necessary, can be supplemented by a colostomy, resection of a necrotic area of an organ, and other forced measures.
During emergency surgery the surgeon’s actions are always aimed only at eliminating the causes of peritonitis, and other reconstructive interventions are postponed for more late date, since their implementation under the current conditions is impossible due to the purulent-inflammatory process. During the first intervention, the doctor always performs intra- and postoperative sanitation of the abdominal cavity and provides decompression small intestine. For this purpose they use antiseptic solutions, which are pre-cooled to +4-6 °C. Their volume may vary depending on clinical case from 8 to 10 liters.
Decompression of part of the small intestine is performed using nasointestinal intubation, which consists of inserting a probe through the nasal cavity into small intestine. In the future, it can be used for the purposes of enterosorption (evacuation of intestinal contents) and artificial nutrition.
Drainage of the colon during surgery to eliminate peritonitis is performed through the anus. At the end of the intervention, drainage from vinyl chloride is always installed in the abdominal cavity. In the future, such a system of tubes is used to remove exudate that continues to accumulate and administer antibacterial drugs to eliminate pathogenic microorganisms.

After the operation, the patient is prescribed antibacterial drugs, and the elimination of the consequences of intoxication is achieved using infusions of solutions for intravenous administration. To plan drug therapy immunocorrectors, infusions of leukocyte mass and ozonated solutions are added. In addition, it is assigned symptomatic therapy, aimed at eliminating emerging symptoms: pain, flatulence, etc. For this, the following can be used:

narcotic analgesics;
potassium preparations;
ganglion blockers;
anticholinergics, etc.

Some patients are indicated for physiotherapeutic procedures such as diadynamic therapy and electrical stimulation of the intestines.

If possible, plan postoperative treatment The following methods aimed at cleansing the blood are included:

plasmapheresis;
ILBI (intravenous laser irradiation of blood);