Peritonitis

Peritonitis is an inflammation of the peritoneum, the membrane which lines the inside of the abdominal cavity.

Peritonitis is occasionally primary (little direct bacterial infection) but usually occurs after damage to an abdominal organ. Two possibilities then arise: an infection which extends beyond the organ that was initially affected or the contents of a viscera leaking out because of its wall being penetrated, carrying with it bacteria which assault the peritoneum. It is also seen following appendicitis which has not been treated. If it is not treated, peritonitis can be fatal as it was for example to the young brilliant mathematician Evariste Galois.

The following are seen in acute generalised peritonitis:

• Very severe abdominal pain;
• paralysis of the bowel (vomiting, stopping passing faeces);
• fever ;
• tense abdominal muscles producing an appearance of a "rigid abdomen".

Peritonitis can also be localised and not extend over the whole peritoneum. In this case the symptoms depend on the region which is infected. The diagnosis is then more difficult and requires technical instruments such as ultrasounds or CT scans.

Chronic peritonitis also occurs although this is very rare.

Admission to hospital is required. Antibiotic therapy is required in addition to resuscitation to compensate for fluid losses, using intravenous infusions. Surgery must then be attempted to stop the progression of the disease. This then involves for example suturing a perforated ulcer, or removing a loop of intestine or appendix. Finally, the abdominal cavity must be cleaned and a drain inserted to remove the remaining fluid.

Patients are generally hospitalised for a week although the admission may be longer if complications occur.