Peritonitis is the inflammation of the peritoneal cavity. It is an acute life-threatening condition caused by bacteria or chemical contamination of the peritoneal cavity (Figure 2.5). Neglected chemical peritonitis will progress to bacterial peritonitis. The most serious complication caused by peritonitis is intestinal obstruction, which may results in death. Other complications include abscess formation, bacteremia, respiratory failure, and shock. Elderly patient with peritonitis is at greater risk for developing life-threatening complications.
The Major Causes of Peritonitis Include
- Perforated peptic ulcer
- Anastomotic leak following surgery
- Strangulated bowel
- Intra-abdominal abscess
- Hematogenous spread of infective agents such as typhoid or tuberculosis
- Ascending infection: for example, in salpingitis and postpartum
General Management of Peritonitis
The management of patients with peritonitis should be started immediately.
- Resuscitation: general patient care with intravenous fluids
- Naso-gastric tube insertion (NGT)
- Monitoring input and output by catheterization
- Surgery to control source of infection and do drainage and peritoneal lavage
Pre Anesthetic Consideration
- Consider the anesthetic management for intestinal obstruction and emergency patient
- Aggressive fluid management is essential. The first priority is to restore intravascular volume and perfusion. Initial resuscitation should be with crystalloid and/or colloid to maintain hydration and perfusion.
- Insert a nasogastric tube and commence aspirations to reduce pressure within the bowel
- Oxygen should be administered in preoperative period especially if hypotensive or with an oxygen saturation of less than 95% on pulse oximetry or arterial blood gas measurement.
- Urinary catheter: start hourly measurement of urine output and use to guide fluid therapy.
- Give antibiotics
Intra Operative Care
- Consider the intraoperative care for intestinal obstruction
- The same as for care for intestinal obstruction.