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Acute Peritonitis

Acute peritonitis is an inflammation or infection of the peritoneum, classified as either primitive or secondary based on the presence of intra-abdominal lesions. Common causes include appendicitis, perforated ulcers, biliary issues, and sigmoid perforation, with symptoms such as severe abdominal pain, fever, and rigidity. Treatment requires urgent surgical intervention for secondary peritonitis and appropriate antibiotic therapy for primary peritonitis.

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13 views3 pages

Acute Peritonitis

Acute peritonitis is an inflammation or infection of the peritoneum, classified as either primitive or secondary based on the presence of intra-abdominal lesions. Common causes include appendicitis, perforated ulcers, biliary issues, and sigmoid perforation, with symptoms such as severe abdominal pain, fever, and rigidity. Treatment requires urgent surgical intervention for secondary peritonitis and appropriate antibiotic therapy for primary peritonitis.

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ACUTE PERITONITIS

I - DEFINITION

Peritonitis is an acute inflammation or infection of the peritoneum.


membrane that lines the abdominal cavity and the organs it contains.

We talk about primitive peritonitis when there is no intra-abdominal lesion.


responsible: example of tuberculous peritonitis. We are talking about secondary peritonitis
when there is an intra-abdominal focus responsible for the infection.

II - ETIOLOGY

1- Appendicitis

The most common, especially in young subjects. Most often follows a


appendicular crisis but can occur initially, after perforation or gangrene
of the appendix. The picture is that of a frank purulent peritonitis whose
signs predominated in the right iliac fossa. The rectal examination is very painful.
right.
2- Perforation of gastric-duodenal ulcer

The most brutal, stabbing pain, of which one can specify the timing.
exact. Young man, muscular, caricatural depiction of a wooden belly. Possible
ulcer history, the intake of anti-inflammatories, the site of pain, the
Gaseous crescents under the diaphragm allow for easy diagnosis.
3- Biliary peritonitis

Occur by vesicular perforation (gangrene) or by transudation


purulent through a distended porous wall but not perforated. These
lesions are due to an infected gallstone disease, most often in
elderly subjects.

4- Sigmoid perforation

This is the perforation of an inflamed sigmoid diverticulum, with leakage of


pus and substances in the peritoneum: pyostercoral peritonitis, highly septic.
5- Other etiologies

post traumatic, often mixed with hemoperitoneum.

of genital origin, after salpingitis.


post-operative, after abdominal visceral surgery

III- CLINICAL SIGNS

1-Functional signs

Sudden abdominal pain, the location of which depends on the


cause. Very intense, severe, continuous pain exacerbated by everything
movements.
Frequent vomiting.
Intermittent intestinal transit stoppage....

2-General signs

Fever > 38.5 °C, depending on the cause and the duration of the peritonitis.
Increased pulse, normal or low blood pressure.
Deterioration of general condition.

3-Physical signs

auscultation: abolition of normal bowel sounds.


Inspection: the patient is pale and rigid, with a peritoneal face, he has
constantly thirsty and there is no abdominal breathing.
Palpation: the main symptom of peritonitis is rigidity.
abdominal which is an involuntary manifestation of the abdominal wall
making it rigid (wooden belly), toned thanks to the musculature
abdominal, permanent, invincible and painful; but it is a sign
inconstant, the peritoneal defense being more frequent.
percussion: dullness or tympanites.
pelvic touches: sharp and exquisite pain from the Douglas pouch.

4-Additional examinations

biology: hyperleukocytosis and signs of hemoconcentration.


X-ray: on an abdominal image without preparation (if possible in
standing or sitting, at worst in a lateral decubitus position, the patient being
lying on the side) we will be able to observe the existence of an effusion
air or pneumoperitoneum characterized by the presence of air under the
diaphragmatic domes.

IV- THE DIFFERENTIAL DIAGNOSIS

It occurs with other acute abdominal hyperalgesic syndromes.


accompanied by a pseudo-contraction (acute non-perforated ulcer, colics
hepatic or nephritic) but also in the elderly in whom the
contracture is not clear with other surgical syndromes (occlusion,
necrotizing pancreatitis, mesenteric infarction.

V- Treatment

Spontaneous bacterial peritonitis (primary peritonitis).


An appropriate antibiotic therapy must be initiated as quickly as possible.

Secondary peritonitis.
Acute peritonitis requires extremely urgent surgical treatment.
The early diagnosis and treatment condition the vital prognosis of
subject.
It adheres to four fundamental principles:

PRINCIPLE I (REPAIR): control of the source of infection;

PRINCIPLE 2 (TOILET): evacuate the inoculation of bacteria, pus


and by peritoneal toilet;
PRINCIPLE 3 (DRAINAGE): drainage of the different compartments
inner abdominals;
PRINCIPLE 4 (PREVENTION): prevent and treat potential issues.
persistent infections or infectious relapses.

DR BOUAB

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