Peritonitis

WHAT YOU SHOULD KNOW

Peritonitis is an inflammation of the inner lining of the abdominal cavity (the peritoneum), often as a result of infection.

Causes

Typically, this disorder follows the rupture of an organ in the abdomen, allowing bacteria within the organ to spread into the abdominal cavity. Often caused by a burst appendix or gallbladder, it can also result from a perforation in the wall of the stomach or intestine.

Sexually active women can develop peritonitis if they suffer from pelvic inflammatory disease—an infection of the uterus and fallopian tubes that can migrate into the abdomen.

Peritonitis is also easily triggered by surgical procedures in the abdominal area. For example, leakage can occur during routine procedures in which intestinal segments are joined, or following surgical trauma to the gallbladder, urinary bladder, or intestine. Even the talc or starch on a surgeon's glove can cause peritonitis.

In some cases, the inflammation that marks peritonitis develops without an infection, as when an inflamed pancreas leads to the problem.

Signs/Symptoms

The hallmark of peritonitis is severe abdominal pain that's made worse by movement. Other symptoms include fever, nausea, vomiting, and dehydration.

Care

Peritonitis is a medical emergency that must be dealt with immediately. Treatment depends upon the cause, but generally involves surgery. An operation called a laparotomy is performed first. Through a surgical incision in the abdominal wall, the doctor examines the cavity, confirms the diagnosis, and corrects the problem by removing or repairing the source of the infection. If the appendix is at fault, for example, an appendectomy is performed to remove it.

Risks

Left untreated, peritonitis can lead to shock, and even death. Complications from this disorder develop rapidly and include fluid retention in the upper and lower intestines, a halt in the normal movement of food and waste through the digestive tract, and a loss of electrolytes (minerals such as sodium and calcium) from the bloodstream. In the end, lung, kidney, and liver failure can result, along with widespread clotting inside the body.

WHAT YOU SHOULD KNOW

Seek Care Immediately If...

• You develop severe abdominal pain. THIS IS AN EMERGENCY. Call 911 or 0 (operator) to get to the nearest hospital or clinic. Do not drive yourself!

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

You may experience the following procedures and equipment during your stay.

• X-ray: This picture of the inner abdomen will show whether a perforation has occurred. You may have these x-rays done both while standing and lying down.
• Taking Vital Signs: These include your temperature, pulse, blood pressure, and respiration. A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm. These tests may be performed hourly.
• IV: A tube placed in your vein for giving medications, such as antibiotics to fight infection, and liquids to replace lost fluids. You may be given several antibiotics at once.
• Nasogastric Tube: This is a tube that is threaded through your nose or mouth and down into your stomach. It can be attached to a suction device that removes gas and fluid to reduce nausea and vomiting.
• Withdrawing Abdominal Fluid: In this procedure, the doctor pulls fluid from the abdomen with a needle. The fluid is then analyzed to identify the germs at fault and determine which antibiotic will kill them.
• Surgery: Emergency surgery is usually required. The operation typically takes between two and three hours.
• During the Laparotomy...
  • You will be given general anesthesia to put you to sleep and eliminate pain.
  • A catheter, a thin tube used to drain urine, will be inserted through your urethra and into your bladder to prevent urine from accumulating during the surgery.
  • The surgeon will cut through the abdominal wall and explore the entire cavity for the source of the infection and inflammation.
  • Any diseased organ he discovers will be removed or repaired.
  • When the operation is finished, the incision will be closed and a dressing will be applied.
• After Surgery:
  • You will be returned to your room. You will probably need to stay in the hospital for two to three days, perhaps longer depending on your recovery.
  • For the first two or three days, you may be restricted to a liquid diet.

After You Leave

• Follow your doctor's orders regarding medications, activities, and follow-up appointments. Complete recovery may take between four and six weeks.
• Keep the site of the surgical incision clean. Be sure to follow your doctor's instructions for changing bandages and dressings. Wait at least 1 day before removing the bandages to bathe.
• Get out of bed and walk as soon as you feel up to it.
• Do not resume other normal activities until you feel up to doing them. You will probably tire easily for a few days, and your doctor may restrict your activity for the first few days following the surgery.
• Avoid strenuous work and sports until your doctor gives the okay.

Seek Care Immediately If...

• You develop fever, chills, sweating, nausea, diarrhea, vomiting, or abdominal pain or tenderness.
• Your incision becomes red or puffy, or begins oozing liquid.

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