Spilled peritonitis: causes, symptoms, diagnosis, prescribed treatment, recovery period

Peritonitis is a rather serious disease, fraught for the patient not only with a number of complications, but also with a great chance of death. Everyone needs to know the symptoms of spilled peritonitis. In addition to signs, we consider the characteristics, causes of development, types of the disease, especially the diagnosis, treatment and prevention.

What is this disease?

Spilled peritonitis is an inflammatory process that affects the parietal and visceral sheets of the peritoneum. It can have both aseptic and bacterial origin. First of all, it is associated with a serious general condition of the patient. This is due to multiple organ failure.

Let us turn to anatomy to better understand what diffuse peritonitis is. The peritoneum sheets are serous membranes consisting of mesothelium - a single-layer type of epithelium. They are divided into two categories:

• Visceral epithelium - covers the internal organs of the peritoneum.
• Parietal (or parietal) - lines the walls of the abdominal region itself.

As soon as inflammation occurs in the peritoneum, the serous membrane immediately tries to protect healthy neighboring tissues from the inflammatory focus by creating so-called adhesions. This is local peritonitis. In the case when such a barrier is unsuccessful (inflammation spreads to neighboring areas), the process is already acquiring an extensive, diffuse character. Spilled peritonitis develops.

According to statistics, 15-20% of patients admitted to hospitals with a diagnosis of peritonitis need immediate surgical intervention. Mortality among patients is high - 40-50% of cases.

Doctors refer spilled peritonitis of the abdominal cavity to the group of pathologies under the general name "acute abdomen." That is, to acute forms requiring immediate surgical intervention.

Causes of Aseptic Peritonitis

Spilled purulent peritonitis is considered aseptic if the cause of the inflammation is not associated with foreign pathogens. So what causes the disease?

Several reasons stand out:

• The effect of pancreatic enzymes. It manifests itself in acute pancreatitis, peritoneal injuries.
• Hemoperitoneum - the allocation of blood into the extraperitoneal space. The reasons are the same.
• Rupture of an ovarian cyst.
• Exposure to a barium mixture. An extremely rare case. This is the output of a barium mixture beyond the gastrointestinal tract. It is used for x-ray examination of the gastrointestinal system.

Causes of bacterial peritonitis

The aseptic form of the disease, I must say, is quite rare. The most common causes of diffuse diffuse peritonitis are rupture of hollow organs, surgery, trauma, which led to damage to the peritoneal organs and infection.

The most common pathogens of the bacterial form of the disease are the following:

• Own nonspecific conditionally pathogenic microflora inhabiting the gastrointestinal tract.
• Varieties of Pseudomonas aeruginosa.
• E. coli.
• Mycobacterium tuberculosis (Koch's bacillus).
• Gonococcus (the causative agent of gonorrhea) and so on.
  

Primary pathway of the disease

This is a rather rare variety of diffuse peritonitis of the abdominal region: it occurs in 1.5% of cases. It develops when bacteria, viruses and fungi enter the peritoneum in three ways:

• Lymphogenic With lymph through the lymphatic vessels.
• Hematogenous. With blood flow.
• Peritubular. Through the fallopian tubes in women.

In this case, the disease can also be caused by such microorganisms as pathogens of tuberculosis, gonorrhea, salpingitis.

Secondary pathway of disease

Spilled purulent peritonitis is most often the result of another pathological process. That is, it is a secondary pathology with:

• Complications of diseases affecting the stomach, duodenum, liver and pancreas. Most often, acute diffuse peritonitis causes purulent appendicitis (an appendix that bursts and pours out with pus).
• Complications of diseases affecting the small intestine. This is a perforation of the diverticulum, tumor, acute obstruction of the small intestine, blood clots in the mesenteric vessels.
• Diseases of the large intestine. In particular, perforation of its departments in UC, Crohn’s disease, typhoid ulcers, acute intestinal obstruction.
• Injuries to the abdominal organs with the subsequent exit of the infected mass.
• Postoperative consequences. This is damage to the walls of organs by the surgeon, insolvent anastomoses, teething sutures and ligatures.

Disease classification

In the medical world, there are several gradations of the forms of this disease. We will briefly introduce them.

Due to occurrence:

• Traumatic.
• Postoperative.
• Perforated.
• Infectious.

By the presence / absence of pathogenic microorganisms:

• Bacterial
• Aseptic.

By the nature of occurrence:

• Primary
• Secondary

By prevalence in the anatomical region of the peritoneum:

• Local (or local).
• Limited.
• Diffuse (common).

According to the characteristic of inflammation:

• Spilled serous peritonitis.
• Hemorrhagic.
• Spilled fibrinous peritonitis.
• Purulent peritonitis.

As the contents poured into the peritoneum:

• Fecal.
• Uric.
• Gall.
• Hemorrhagic.

Disease development phases

Spilled fibrinous-purulent peritonitis, like other forms of the disease, develops in several phases:

1. Reactive.
2. Toxic
3. Terminal.

Each of them is distinguished by special symptoms. Therefore, it makes sense to present the stages in detail.

Symptoms of the reactive phase

In the first day of the lesion, acute peritonitis is almost not manifested. If the patient feels unwell, this is associated with the underlying disease.

Further, the reactive stage of the disease begins to manifest itself as follows:

• Severe pain in the peritoneum.
• Vomiting of stomach contents.
• Fever.
• Increased pulse.
• Unreasonably rapid breathing.
• Dry mouth. Moreover, the patient complains of constant thirst.
• The patient is in an unnatural constrained pose. Most often this is the position of the embryo. Due to the fact that in this position the pain subsides a little.

As the inflammatory process spreads to new areas, the patient's condition begins to change, worsen:

• A person practically does not breathe in the stomach - this becomes painful for him.
• On palpation, the specialist determines that the muscles of the abdominal anterior wall are tense.
• A sharply positive peritoneal symptom (Shchetkina - Blumberg).
• With vaginal and rectal examination, sharp pain appears in the pelvic peritoneum.

At the end of the second day, an imaginary improvement may come with amelioration of symptoms.

The fluid in the peritoneal area at this time will be transparent - fibrous-serous or just serous type. At the reactive stage, its amount rapidly increases, and by its end it already becomes purulent.

Symptoms of the toxic stage

The phase occurs after 24-72 hours from the onset of the development of the disease. First of all, it is characterized by a sharp deterioration in the patient's condition. Symptoms are as follows:

• An increase in body temperature.
• Loss of consciousness.
• Change in respiratory rate. It itself becomes noisy.
• Weak pulse. Sometimes almost threadlike.
• A person is constantly tormented by thirst.

External manifestations:

• The patient's face resembles the so-called "Hippocratic mask" - haggard, sunken cheeks, sunken eyes.
• Dry lips.
• The tongue is also dry, coated with a touch of grayish tint.
• The patient does not breathe in the stomach.
• The abdomen on palpation is plank-like (due to muscle tension).

The following symptoms may be added:

• Decrease in the amount of urine excreted by the body.
• Bloating.
• Loss of consciousness.
• Lack of peristalsis of the intestinal tract due to its paresis.

An ultrasound scan shows the presence of free fluid in the abdominal cavity. Her character may be purulent-hemorrhagic or purulent-fibrous.

Symptoms of the terminal stage

The terminal phase is called, starting after 72 hours from the onset of the disease. It is characterized by an extremely serious condition of the patient. The main features are as follows:

• The person is immobilized.
• Depressed consciousness (to coma).
• Intoxication of the body is visible by the aggravated signs of the previous stage.
• Symptoms of multiple organ failure.
• Filamentous pulse.
• The skin is cyanotic, grayish, very pale.
• Weak breathing (sometimes it is necessary to maintain the vital activity of the patient using a mechanical ventilation device).
• Renal failure is expressed in a sharp decrease in the volume of urine excreted or in the complete absence of urine.
• Vomiting is already intestinal contents (excreted by fecal odor).
• Progressive intestinal paresis.
• One of the dangerous manifestations is septic shock.
• The abdominal muscles noticeably weaken (in contrast to the extremely stressed state in the previous stage).

Fatal outcome at this stage of the disease is 50% of cases.

Diagnosis of the disease

The best escape from death is an early diagnosis of peritonitis. Includes the following activities:

• Medical history - the relationship of the condition with injuries, operations on the organs of the peritoneum, etc.
• Assessment of patient complaints, severe clinical symptoms.
• Palpation of the abdomen. The doctor draws attention to peritoneal symptoms and tension of the abdominal muscles.
• Blood test is general clinical. The study helps to identify the onset of the inflammatory process by accelerating ESR, a shift in the leukocyte formula.
• Biochemical blood test. Pathology can be identified by increased acute phase markers.
• Survey x-ray examination of the peritoneum. In the case of perforation of a hollow organ, free air in the cavity will be visible.
• Ultrasound of the peritoneal organs. Indicates the presence of free fluid.
• CT scan.
• Diagnostic laparoscopy. The method is applicable if the above studies do not allow an accurate diagnosis.
• Back sowing the contents of the abdominal cavity. Identification of the type of pathogenic microorganism that caused purulent inflammation. This is necessary to determine its sensitivity to certain antibiotics.

Disease treatment

The success of therapy depends on the time of a certain diagnosis. Treatment of diffuse peritonitis involves the following measures:

• Surgical intervention. Operation with diffuse peritonitis - removal or resection (removal of a certain part) of purulently altered organs. Next, the abdominal cavity is washed, treated with antiseptics. Open the peritoneum with a median laparotomy (a cut along the midline of the abdomen). The technique allows you to carefully examine the abdominal cavity, gain access to all inflamed organs, sanitize the internal space.
• Elimination of paralytic ileus with a number of medications.
• Gastrointestinal decompression.

Postoperative period

The recovery phase (after surgery) includes the following activities:

• Infusion of solutions that can restore acid-base, water, electrolyte balance in the patient’s body.
• Restoration of the functions of the liver, kidneys, pancreas, support of their vital functions.
• Drug therapy - the introduction of antibiotics. Drugs are used to which the identified pathogen is sensitive.

Experts advise a patient who has spilled peritonitis to strictly adhere to the following recommendations:

• Prevention of dysbiosis - taking probiotics and eubiotics.
• Proper nutrition - refusal of foods high in sugar, bakery products.
• The predominance of the food menu is high in fiber, dairy and sour milk products.

Possible complications

Against the background of diffuse peritonitis, the following pathologies often develop:

• Acute renal failure.
• Dehydration
• Toxic shock.
• Pneumonia of stagnant type.

Spilled peritonitis is a dangerous, rapidly developing disease with a high probability of death. However, there are no specific preventive measures that can protect against this disease. Doctors advise to adhere to a healthy lifestyle, timely fight even with seemingly frivolous ailments, do not self-medicate, and urgently seek qualified medical help if you find disturbing symptoms.