Consider what intestinal peritonitis is. The abdominal cavity contains important organs, among which the intestines play a special role. The inner lining of the abdominal cavity forms a sterile closed system that can negatively affect pathogens, neutralizing them. In case of violation of the integrity of the intestine or the sterility of the peritoneum, favorable conditions are created for the development of the inflammatory process.
This is a diffuse or local process of inflammation of the serous cover of the peritoneum (abdominal cavity). Clinical signs of intestinal peritonitis are abdominal pain, muscle tension of the abdominal walls, nausea and vomiting, hyperthermia, gas and stool retention, and a serious general condition. Diagnosis of pathology is based on information from the anamnesis, determination of positive peritoneal symptoms, X-ray data, ultrasound, rectal and vaginal examinations, and laboratory testing. Treatment of purulent intestinal peritonitis is usually surgical (laparotomy, sanitation of the abdominal cavity) with adequate pre- and postoperative detoxification and antibacterial therapy.
Peritonitis is a severe complication of inflammatory and destructive diseases in the abdominal cavity, which is accompanied by severe general and local symptoms, the occurrence of multiple organ failure. The overall mortality from gastroenterological peritonitis is approximately 20-30%, and in more severe forms - 40-50%. Let's take a closer look at what intestinal peritonitis is.
Features of pathology
The specific characteristics of this pathological process are due to the structure of the abdominal cavity. The peritoneum is formed by two serous sheets, passing into each other - parietal and visceral. They cover the walls of the abdominal cavity and internal organs. The peritoneum is a semipermeable, actively functioning membrane that performs many important functions:
- barrier (antimicrobial and mechanical protection of internal organs);
- resorptive (absorption of lysis products, exudate, necrotic tissues, bacteria);
- exudative (processes of secretion of serous fluid), etc.
An important protective property of the peritoneum is its ability to delimit the inflammatory process in the peritoneum due to fibrous adhesions and scars, as well as cellular and humoral mechanisms. In diseases of the intestine, this organ developspathogenic microflora that goes beyond its walls and provokes infection of the peritoneum.
Aseptic type peritonitis is provoked by tissue irritation by aggressive substances of the body itself - urine, blood, bile, stomach or pancreatic juice. It quickly acquires a bacterial character, since after a few hours the peritoneal tissues are exposed to pathogenic bacteria. A variation of aseptic intestinal peritonitis is barium peritonitis, which develops due to the release of barium from the intestine.
This becomes possible when conducting x-ray studies using a contrast agent, which contains barium. This type of disease is rare, but every second patient dies from it. Also known is serous peritonitis of the intestine, which appears due to the accumulation of serous fluid.
Reason for development
To understand what intestinal peritonitis is, let's find out what its causes are. Among most cases of the development of the disease, the causative agent of the pathological process is a bacterial infection, which consists of a nonspecific microflora of the digestive tract: Enterobacter, Escherichia coli, Streptococcus, Staphylococcus, etc. In some cases, this pathology can be caused by a specific microflora: gonococci, Mycobacterium tuberculosis, etc.
If peritonitis of the small intestine or large intestine initially has a bacterial nature of origin, for example, toxic-chemical, thenafter a short time, it acquires a microbial character due to the attachment of infectious pathogens from the lumen of the digestive tract.
The most common causes of intestinal peritonitis are destructive and inflammatory diseases:
- colon diverticulitis;
- Meckel's diverticulum;
- acute destructive appendicitis;
- perforated duodenal ulcers;
- rupture of the intestine after surgery or injury;
- intestinal obstruction.
Intestinal peritonitis can sometimes occur after abdominal surgery due to anastomotic leaks, mechanical damage to the peritoneum, ligation defects, etc.
In order to correctly assess the condition of a patient admitted to the hospital with a suspected disease, a specialist needs to familiarize himself with the symptoms and determine the stage of the pathology. The causes of intestinal peritonitis also need to be clarified.
Stages of disease
The disease almost always proceeds rapidly, in an acute form. This pathology is characterized by rapid and rapid dynamics of development, an extremely serious condition of the patient and death in the absence of effective surgical therapy. The chronic form of the disease is detected in very rare cases.
The symptoms of intestinal peritonitis differ depending on the stage of the course. In medicine, 3 stages of the development of the disease are distinguished:
- Reactive stage, which can last up to 1 day.
- Toxic phase lasting up to about 2-3 days.
- Terminal stage, which develops 4-5 days after the onset of the first symptoms.
To fully understand the dynamics of the development of pathology, detailed information is needed on all its manifestations, from the very first days.
Symptoms of intestinal peritonitis
At the reactive stage, the following symptoms develop:
- sudden severe and acute pain localized in the area of inflammation;
- loss of consciousness;
- tension of the anterior wall of the peritoneum;
- hyperthermia;
- rapid weak pulse;
- plaque on gray tongue;
- false urge to urinate or defecate;
- nausea and vomiting with no relief.
At this stage of the disease, one can notice the maximum manifestation of local symptoms caused by a hyperergic reaction to developing peritoneal irritation. Symptoms of intestinal peritonitis may be different.
At the next stage, toxic, which can last up to 2-3 days, there is an increase in the general intoxication of the body. At the same time, the following pathological signs begin to manifest themselves clearly:
- temperature increase to high values;
- convulsive syndrome;
- lower blood pressure;
- pallor of the skin;
- h alt breathing;
- dehydration;
- pointy facial features;
- distributionsoreness all over the abdomen;
- uncontrollable foul-smelling vomiting.
If during this period the patient is not provided with urgent medical care, the pathological process passes into the last, terminal phase of its development. It is characterized by the following symptoms of intestinal peritonitis in adults and children:
- bluish skin tone;
- paralysis of the nerve endings of the abdominal cavity, which leads to a decrease in abdominal tension and pain;
- decrease in body temperature;
- feverish, chills;
- sunken eyes and cheeks;
- confusion due to intoxication of the body;
- ill-defined pulse and blood pressure;
- weak breathing.
Terminal phase intestinal peritonitis in the medical literature is considered irreversible, inevitably leading to the death of the patient.
Primary diagnostics
If peritonitis of the intestine is suspected, it is necessary to carry out diagnostic measures simultaneously with the provision of emergency medical care. To avoid life-threatening complications, an accurate diagnosis of the patient must be made no later than 2 hours from the onset of the disease.
In the process of diagnosing intestinal peritonitis, the following information should be taken into account:
- presence of peritoneal symptoms;
- abdominal x-ray and ultrasound data;
- peritoneal puncture data;
- result of diagnostic laparoscopy;
- lab results.
The initial diagnosis can be made on the basis of the general clinical picture of the disease. Specialists pay special attention to the pain syndrome during the initial examination of the patient. For this, a number of modern methods are used (for example, the Shchetkin-Blumberg method), which can confirm the development of intestinal peritonitis in a patient. With independent relief of the pain syndrome with the help of various pain medications, a reliable clinical picture can be greatly distorted.
Laboratory diagnostics
In the implementation of diagnostic measures for intestinal peritonitis, an important place is occupied by the results of a biochemical blood test. Through this analysis, pathological changes in the composition of the blood are determined: an increase in ESR, high leukocytosis, neutrophilia, a purulent-toxic shift of the leukocyte formula to the left. These changes indicate the development of purulent intoxication in the body.
When conducting fluoroscopy of the peritoneum under the dome of the diaphragm, air is visible, the presence of fluid in the intestine, swollen loops, which indicates paralytic obstruction. With the help of fluoroscopic examination using a contrast agent, the failure of the anastomotic sutures is easily established, which is the most common cause of intestinal peritonitis that occurs after surgery. Free fluid in the peritoneal cavity is well defined by ultrasound.
Find out if surgery is performed for intestinal peritonitis.
Surgical diagnostics
If the above diagnostic measures do not give a complete picture of the disease and do not allow an accurate diagnosis, specialists resort to more complex, but highly effective diagnostic methods, such as laparocentesis and laparoscopy of the abdominal cavity. Using these methods, you can accurately determine the nature and cause of the pathological process.
The patient's severe condition often requires emergency diagnosis. In certain cases, the diagnosis is made directly during the intervention after opening the peritoneum.
Treatment
In case of intestinal peritonitis, only emergency surgical treatment in a medical facility is used. At home, it is not possible to treat such a pathology. A timely visit to the doctor gives the patient a chance for a favorable prognosis of surgical interventions.
Before the operation, it is necessary to carry out preparatory procedures:
- stop pain shock;
- stabilize the water-s alt balance;
- normalize blood pressure.
Surgical treatment is performed under general anesthesia. Often doctors use a wide median laparotomy. During the intervention, the activity of all vital organs is controlled and supported. The main phases of surgical treatment are:
- elimination of the infectious focus;
- sanitation of the abdominal cavity with special antibacterial and antiseptic solutions;
- peritoneal drainage for oral administrationantibacterial medicines and removal of exudate accumulated in it;
- removal of the inflammatory process;
- elimination of paralytic ileus in order to restore normal peristalsis.
In severe cases, the peritoneum is flushed with special solutions, which is called “peritoneal lavage” in medicine.
Post-op care
After surgery, it is mandatory to continue conservative treatment, the main directions of which are:
- prescribing strong antibacterial drugs and saline infusions to the patient to eliminate intoxication of the body;
- restoring damaged systems;
- stimulation of the intestinal musculature;
- maintaining the work of the respiratory, cardiovascular, nervous systems;
- immunity boost.
In the treatment of intestinal peritonitis, modern additional methods are also used: plasmapheresis, UV irradiation of blood, hemosorption, etc.
Recently, in the postoperative treatment of such pathologies, relaparotomy is actively used, the essence of which is a thorough washing of the peritoneal cavity with a special composition. These procedures can be carried out 2-3 days after the operation, which directly depends on the patient's well-being.
What is peritonitis of the intestine, now it is clear, but what is the prognosis?
Forecast
Prognosis for recovery depends on the timely implementation of therapeutic measures, as well as on the effectiveness of postoperative treatments. An important role is played by the causes of the pathology and the severity of its course. There are frequent cases of peritonitis with intestinal obstruction. In advanced situations, severe complications and death are possible.
Measures to prevent such a dangerous disease include a he althy lifestyle, proper nutrition, timely medical examinations.
We looked at what intestinal peritonitis is. The symptoms and treatment were also detailed.
