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Peritonitis: symptoms and treatments

Peritonitis refers to acute inflammation of the peritoneum, a membrane that covers the abdominal cavity. Most often of infectious origin, peritonitis is a medical emergency because it can be life-threatening.

What is peritonitis?

Peritonitis is an acute inflammatory disease in the abdomen . It occurs more exactly at the level of the peritoneum, the membrane that surrounds the viscera of the abdominal cavity.

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What are the different types of peritonitis?

Depending on the extent and course of inflammation, peritonitis can be considered as:

  • localized peritonitis ;
  • generalized peritonitis.

This inflammation can also be classified according to its origin. There are two main types:

  • primary peritonitis that is due to spontaneous infection with the initial absence of intraabdominal lesions;
  • secondary peritonitis, the most common, which is caused by an infection due to intra-abdominal injury and the presence of an intraabdominal infectious focus.

What are the causes of peritonitis?

Peritonitis is most often of infectious origin.

When infection of the peritoneum is spontaneous, peritonitis is said to be primary and may be due to different pathogenic strains. In particular, there is pneumococcal peritonitis and tuberculous peritonitis.

Representing 90% of acute inflammations of the peritoneum, secondary peritonitis can be caused by:

  • intra-abdominal infection or perforation , such as appendicitis , perforation of a peptic ulcer , sigmoid diverticulitis , or cholecystitis ;
  • a postoperative event , which can occur in case of intraoperative contamination or anastomotic disunion;
  • a post-traumatic event , which can be a penetrating wound, a closed trauma with perforation, a digestive ischemia, an endoscopic perforation or a perforation by a foreign body.

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What is the risk of complication?

Peritonitis can be localized or generalized to the whole organism. This is called sepsis . Generalized peritonitis is a medical emergency because it is life-threatening.

What are the symptoms of peritonitis?

Peritonitis is characterized by the occurrence of intense, localized or generalized abdominal pain, of sudden or progressive onset. This abdominal pain is associated with contracture of the muscles in the abdominal belt. Rigid, tonic, permanent and painful, this abdominal contracture is often called “belly of wood”.

In addition to pain in the abdomen, peritonitis can be manifested by other symptoms such as:

  • vomitings ;
  • Stopping feces
  • a diarrhea ;
  • infectious signs such as fever;
  • a great fatigue;
  • an alteration of the general state.

How to diagnose peritonitis?

The diagnoctic of peritonitis may require different exams such as:

  • a clinical examination to assess perceived symptoms;
  • blood tests for the presence of pathogenic germs;
  • medical imaging examinations, such as radiography or ultrasound , to visualize the abdominal cavity.

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Treatment of primary peritonitis

In case of spontaneous infection, primary peritonitis requires hospitalization to look for and treat the pathogen. Before identification of the infectious strain, temporary antibiotic therapy is usually established.

Treatment of secondary peritonitis

Like primary peritonitis, secondary peritonitis requires hospitalization and antibiotic therapy. Nevertheless, it is also often based on a surgical treatment that consists of removing the infective intraabdominal focus. The surgical procedure depends on the origin and the evolution of the peritonitis. It can for example be:

  • an appendectomy, which is a total removal of the appendix;
  • a suture of a peptic ulcer;
  • a gastrectomy, which is a partial or total removal of the stomach;
  • a colectomy, which is a removal of the colon.

Surgical treatment of secondary peritonitis is usually accompanied by peritoneal lavage, which removes the infected peritoneal fluid.

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