Acute Suppurative Peritonitis

Lu Ning, PhD, MD

General Surgery Department

Tianjin University Hospital

THE PERITONEUM & ITS FUNCTIONS

Lubrication and protection--- Intraperitoneal circulation Nearly 1 m2 of the total 1.7 m2 area participates

in fluid exchange with the extracellular fluid Rate: 500 mL or more per hour. Normally, there is less than 50 mL of free perito

neal fluid: From other sites towards subdiaphragmatic regi

ons bilaterally

THE PERITONEUM & ITS FUNCTIONS

Characteristics of peritoneal transudate: specific gravity below 1.016 protein concentration less than 3 g/dL white blood cell count less than 3000/uL complement-mediated antibacterial activity lack of fibrinogen-related clot formation.

PERITONITIS

Definition---an inflammatory or suppurative response of the peritoneal lining to direct irritation.

Inflammatory response of peritoneaum increased blood flow increased permeability formation of a fibrinous exudate on its surface

PERITONITIS

Primary or spontaneous peritonitis can occur as a diffuse bacterial infection without an obvious intra-abdominal source of contamination.

Secondary peritonitis results from bacterial contamination originating from within viscera or from external sources (eg, penetrating injury).

Causations of Peritonitis

Common causes of peritonitis.

Severity Cause Mortality Rate

Mild AppendicitisPerforated gastroduodenal ulcersAcute salpingitis

<10%

Moderate Diverticulitis (localized perforations)Nonvascular small bowel perforationGangrenous cholecystitisMultiple trauma

<20%

Severe Large bowel perforationsIschemic small bowel injuriesAcute necrotizing pancreatitisPostoperative complications

20-80%

Clinical Findings ---pain

Clinical Findings--Local findings

Signs that reflect parietal peritoneal irritation and resulting ileus Peritonitis sign

Tenderness Rebound tenderness Guarding or rigidity

Distention Free peritoneal air Diminished bowel sounds

Clinical Findings --Systemic findings

Fever, chills or rigors, tachycardia, sweating, tachypnea, restlessness, dehydration, oliguria, disorientation, and, ultimately, refractory shock.

Diagnostic Imagine

B-usAbdominal Plain filmCT scan

Diagnostic Imagine

Diagnostic Imagine

Diagnostic Imagine

Diagnostic Imagine

Treatment ---Preoperative Care

1. Intravenous 2. Care for advanced 3. Antibiotics

Treatment ---Operative Managenment

Objectives of surgery for peritonitis Complete Debridment:remove all infected mater

ial Correct the underlying cause Prevent late complications.

Treatment ---Operative Managenment

Control of sepsis Peritoneal lavage Peritoneal drainage Management of abdominal distention

Complications

Deep wound infectionsResidual abscesses Intraperitoneal sepsisAnastomotic breakdownFistula formation