Consider what intestinal peritonitis is. Important organs are located in the abdominal cavity, among which the intestines play a special role. The inner lining of the abdominal cavity forms a sterile closed system that can negatively affect pathogens, rendering them harmless. In case of violation of the integrity of the intestine or the sterility of the peritoneum, favorable conditions are created for the development of the inflammatory process.
This is a diffuse or local process of inflammation of the serous cover of the peritoneum (abdominal cavity). Clinical signs of intestinal peritonitis are abdominal pain, muscle tension in the abdominal walls, nausea and vomiting, hyperthermia, gas and stool retention, and a serious general condition. Diagnosis of the pathology is based on information from the anamnesis, determination of positive peritoneal symptoms, radiography, ultrasound, rectal and vaginal examinations, and laboratory tests. Treatment of purulent intestinal peritonitis is usually surgical (laparotomy, abdominal sanitation) with adequate pre- and postoperative detoxification and antibacterial therapy.
Peritonitis is a serious complication of inflammatory and destructive diseases in the abdominal system, which is accompanied by pronounced general and local symptoms, the occurrence of multiple organ failure. The total mortality from gastroenterological peritonitis is approximately 20-30%, and in more severe forms - 40-50%. We will examine in more detail what intestinal peritonitis is.
Pathology Features
The specific characteristics of this pathological process are due to the structure of the abdominal cavity. The peritoneum is formed by two serous leaves turning into each other - parietal and visceral. They cover the walls of the abdominal cavity and internal organs. The peritoneum is a semi-permeable, actively functioning membrane that performs many important functions:
- barrier (antimicrobial and mechanical protection of internal organs);
- resorptive (absorption of lysis products, exudate, necrotic tissue, bacteria);
- exudative (processes of excretion of serous fluid), etc.
An important protective property of the peritoneum is its ability to delimit the inflammatory process in the peritoneum due to fibrous adhesions and scars, as well as cellular and humoral mechanisms. In diseases of the intestine, pathogenic microflora develops in this organ, which extends beyond its walls and provokes infection of the peritoneum.
Aseptic type peritonitis is provoked by tissue irritation by aggressive substances of the body itself - urine, blood, bile, juice of the stomach or pancreas. It quickly becomes bacterial in nature, since after a few hours the peritoneal tissues are exposed to pathogenic bacteria. A type of aseptic intestinal peritonitis is barium peritonitis, which develops as a result of going beyond the intestines of barium.
This becomes possible when conducting x-ray studies using a contrast agent, in which barium is present. This type of disease is rare, but every second patient dies from it. Also known is serous intestinal peritonitis, which appears due to the accumulation of serous fluid.
Development reasons
To understand what intestinal peritonitis is, we will find out what its causes are. Among the majority of cases of the development of the disease, the causative agent of the pathological process is a bacterial infection, which consists of a non-specific microflora of the digestive tract: enterobacter, E. coli, streptococcus, staphylococcus, etc. In some cases, this pathology can be caused by a specific microflora: gonococcus, mycobacterium tuberculosis, etc.
If peritonitis of the small intestine or colon initially has a bacterial origin, for example, toxicochemical, then after a short time it acquires a microbial character due to the attachment of infectious pathogens from the lumen of the digestive tract.
The most common causes of intestinal peritonitis can be considered such destructive and inflammatory diseases:
- diverticulitis of the colon;
- Meckel's diverticulum;
- acute destructive appendicitis;
- perforated duodenal ulcers;
- rupture of the intestine after surgery or injury;
- intestinal obstruction.
Intestinal peritonitis can sometimes occur after operations in the abdominal cavity due to the failure of the anastomoses, mechanical damage to the peritoneum, defects in the application of ligatures, etc.
In order to correctly assess the condition of a patient admitted to the hospital with suspicion of this disease, the specialist needs to familiarize himself with the symptoms and determine the stage of the pathology. The causes of intestinal peritonitis also need to be clarified.
Stages of the disease
The disease almost always proceeds rapidly, in an acute form. This pathology is characterized by rapid and rapid development dynamics, an extremely serious condition of the patient and a fatal outcome in the absence of effective surgical therapy. The chronic form of the disease is detected in very rare cases.
The symptomatology of intestinal peritonitis differs depending on the stage of the course. In medicine, there are 3 stages of the development of the disease:
- Reactive stage, which can last up to 1 day.
- Toxic phase, the duration of which is up to about 2-3 days.
- The terminal stage, which develops on 4-5 days after the onset of the first symptoms.
In order to fully understand the dynamics of the development of pathology, detailed information about all its manifestations is needed, from the very first days.
Symptoms of intestinal peritonitis
At the reactive stage, the development of the following symptoms is observed:
- sudden severe and acute pain with localization in the area of inflammation;
- loss of consciousness;
- tension of the anterior wall of the peritoneum;
- hyperthermia;
- rapid weak pulse;
- gray plaque;
- false urge to urinate or defecate;
- nausea and vomiting without relief.
At this stage of the disease, you can see the maximum manifestation of local symptoms caused by a hyperergic reaction to developing peritoneal irritation. Symptoms of intestinal peritonitis may be others.
At the next stage, toxic, which can last up to 2-3 days, there is an increase in general intoxication of the body. In this case, the following pathological signs begin to manifest themselves clearly:
- temperature increase to high values;
- convulsive syndrome;
- lowering blood pressure;
- pallor of the skin;
- intermittent breathing;
- dehydration of the body;
- pointy facial features;
- the spread of pain throughout the abdomen;
- uncontrolled vomiting with an unpleasant odor.
If urgent medical care is not provided to the patient during this period, the pathological process goes into the last, terminal phase of its development. It is characterized by the following symptoms of intestinal peritonitis in adults and children:
- bluish skin tone;
- paralysis of the nerve endings of the abdominal cavity, which leads to a decrease in tension of the abdomen and pain;
- decrease in body temperature;
- fever, chills;
- sunken eyes and cheeks;
- confusion due to intoxication of the body;
- poorly defined pulse and pressure;
- weak breathing.
The terminal phase of intestinal peritonitis in the medical literature is considered irreversible, inevitably leading to the death of the patient.
Primary diagnosis
If intestinal peritonitis is suspected, it is necessary to carry out diagnostic measures at the same time as providing emergency medical care. In order to avoid life-threatening complications, an accurate diagnosis of the patient should be made no later than 2 hours from the onset of the disease.
In the process of diagnosing intestinal peritonitis, the following information must be taken into account:
- the presence of peritoneal symptoms;
- abdominal x-ray and ultrasound data;
- peritoneal puncture data;
- result of diagnostic laparoscopy;
- laboratory research indicators.
An initial diagnosis can be made based on the overall clinical picture of the disease. Specialists pay special attention to pain during the initial examination of the patient. For this, a number of modern methods are used (for example, the Shchetkin-Blumberg technique), which can confirm the development of intestinal peritonitis in a patient. With self-management of the pain syndrome using various pain medications, the reliable clinical picture can be greatly distorted.
Laboratory diagnostics
In the implementation of diagnostic measures for intestinal peritonitis, the results of a biochemical blood test occupy an important place. Through this analysis, pathological changes in the blood composition are determined: an increase in ESR, high leukocytosis, neutrophilia, purulent-toxic displacement of the leukocyte formula to the left. These changes indicate the development of purulent intoxication in the body.
When performing a peritoneum x-ray under the dome of the diaphragm, air is visible, the presence of fluid in the intestines, swollen loops, which indicates paralytic obstruction. With the help of a fluoroscopic study using a contrast agent, anastomosis suture failure is easily established, which is the most common cause of intestinal peritonitis that occurs after surgery. Free fluid in the peritoneal cavity is well defined by ultrasound.
We will find out whether surgery is performed for intestinal peritonitis.
Surgical diagnosis
If the above diagnostic measures do not provide a complete picture of the disease and do not allow an accurate diagnosis, specialists resort to more complex, but highly effective diagnostic methods, such as laparocentesis and abdominal laparoscopy. Using these methods, you can accurately establish the nature and cause of the pathological process.
The serious condition of the patient often requires emergency diagnosis. In certain cases, the diagnosis is made directly during the intervention after opening the peritoneum.
Treatment
With intestinal peritonitis, only emergency surgical treatment in a medical institution is used. At home, it is not possible to treat such a pathology. Timely access to a doctor gives the patient a chance for a favorable prognosis of surgical measures.
Before the operation, it is necessary to carry out preparatory procedures:
- stop pain shock;
- stabilize the water-salt balance;
- normalize the pressure.
Surgical treatment is carried out under general anesthesia. Often, doctors use a wide median laparotomy. During the intervention, the activity of all vital organs is monitored and supported. The main phases of surgical treatment are:
- elimination of the infectious focus;
- sanitation of the abdominal cavity through special antibacterial and antiseptic solutions;
- drainage of the peritoneum in order to introduce antibacterial medications into the interior and remove the exudate that has accumulated in it;
- removal of the inflammatory process;
- elimination of paralytic bowel obstruction in order to restore normal peristalsis.
In severe cases, the peritoneum is flushed with special solutions, which is called “peritoneal lavage” in medicine.
Postoperative therapy
After surgery, further conservative treatment is mandatory, the main areas of which are:
- the appointment of a patient with potent antibacterial drugs and infusions of saline to eliminate intoxication of the body;
- recovery of damaged systems;
- stimulation of the functioning of the intestinal muscles;
- maintenance of the respiratory, cardiovascular, nervous systems;
- increase immunity.
In the treatment of intestinal peritonitis, modern additional techniques are also used: plasmapheresis, ultraviolet irradiation of blood, hemosorption, etc.
Recently, in the postoperative treatment of such pathologies, relaparotomy is actively used, the essence of which is a thorough washing of the peritoneal cavity with a special composition. These procedures can be carried out 2-3 days after the operation, which directly depends on the well-being of the patient.
What is intestinal peritonitis, it is now clear, but what is the prognosis?
Forecast
The prognosis for recovery depends on the timely conduct of therapeutic measures, as well as on the effectiveness of postoperative treatment methods. An important role in this is played by the causes of the pathology and the severity of its course. Frequent cases of peritonitis with bowel obstruction. In advanced situations, serious complications and death can occur.
Measures to prevent such a dangerous disease include a healthy lifestyle, proper nutrition, timely medical examinations.
We examined what intestinal peritonitis is. Symptoms and treatment have also been described in detail.