Peritonitis primaria

 
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eMedicine Specialties > General Surgery > Abdomen
Peritonitis and Abdominal Sepsis
Author: Ruben Peralta, MD, FACS, Professor of Surgery, Anesthesia and Emergency Medicine, Senior Medical Advisor, Board of Directors, Program Chief of Trauma, Emergency and Critical Care, Consulting Staff, Professor Juan Bosch Trauma Hospital, DominicanRepublic
Coauthor(s): Thomas Genuit, MD, Assistant Professor, Department of Surgery, Program in Trauma and Surgical Critical Care, University of Maryland School of Medicine; Lena M Napolitano, MD, FACS, FCCP, FCCM, Professor of Surgery, University of Michigan School of Medicine; Chief, Surgical Critical Care, Program Director, Surgical Critical Care Fellowship, Associate Chair, Department ofSurgery, University of Michigan Health System; Sarah Guzofski, MD, Staff Physician, Department of Psychiatry, University of Massachusetts Medical School
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Updated: Aug 2, 2006
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Introduction
Peritonitis is defined as inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. Peritonitis is often caused by introduction of an infection into the otherwise sterile peritoneal environment through perforation of the bowel, such as a ruptured appendix or colonic diverticulum. The disease may also be caused by introductionof a chemically irritating material, such as gastric acid from a perforated ulcer or bile from a perforated gall bladder or a lacerated liver. In women, localized peritonitis most often occurs in the pelvis from an infected fallopian tube or a ruptured ovarian cyst.
For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center, Liver, Gallbladder, andPancreas Center, and Blood and Lymphatic System Center. Also, see eMedicine's patient education articles Abdominal Pain in Adults, Appendicitis, Diverticulosis and Diverticulitis, Cirrhosis, and Sepsis (Blood Infection).
History of the Procedure
Untreated cases of acute peritonitis may be fatal. In 1926, the fundamental role of operative therapy in the treatment of peritonitis was documented.Kirschner (1926) reported that the mortality rate from intra-abdominal infections decreased from more than 90% to less than 40% during the period from 1890-1924 with the introduction of operative management as an effective therapeutic modality.
Current treatment of peritonitis and peritoneal abscesses consists of a multimodality approach directed at correction of the underlying cause, administrationof systemic antibiotics, and supportive therapy to prevent or limit secondary complications due to organ system failure.
Problem
Inflammation and/or infection of the peritoneal cavity are commonly encountered problems in the practice of clinical medicine today. In general, the term peritonitis refers to a constellation of signs and symptoms, which includes abdominal pain and tenderness onpalpation, abdominal wall muscle rigidity, and systemic signs of inflammation. Patients may present with an acute or insidious onset of symptoms, limited and mild disease, or systemic and severe disease with septic shock.
The peritoneum reacts to a variety of pathologic stimuli with a fairly uniform inflammatory response. Depending on the underlying pathology, the resultant peritonitis may beinfectious or sterile (ie, chemical or mechanical).
Peritoneal infections are classified as primary (ie, spontaneous), secondary (ie, related to a pathologic process in a visceral organ), or tertiary (ie, persistent or recurrent infection after adequate initial therapy).
The intra-abdominal infections are usually divided into generalized (peritonitis) and localized (intra-abdominal abscess). This...