PERITONEUM( continued)

Specific treatment of the cause
If the cause of peritonitis is amenable to surgery, operation must be carried out as soon as the patient is fit for anaesthesia.
This is usually within a few hours. In peritonitis caused by pancreatitis or salpingitis, or in cases of primary peritonitis
of streptococcal or pneumococcal origin, non-operative treatment is preferred provided the diagnosis can be made with
confidence.
Peritoneal lavage
In operations for general peritonitis it is essential that, after the cause has been dealt with, the whole peritoneal cavity is
explored with the sucker until all seropurulent exudate is removed. The use of a large volume of saline (1–2 litres) containing dissolved antibiotic (e.g. tetracycline)has been shown to be effective
Prognosis and complications
With modern treatment, diffuse peritonitis carries a mortality rate of about 10%.
Summary box 58.8
Systemic complications of peritonitis Abdominal complications of peritonitis
? Bacteraemic/endotoxic shock ? Adhesional small bowel obstruction

? Bronchopneumonia/respiratory failure ? Paralytic ileus

? Renal failure ? Residual or recurrent abscess
? Bone marrow suppression
? Multisystem failure ? Portal pyaemia/liver abscess
Summary box 58.7
Management of peritonitis

General care of patient:
? Correction of fluid and electrolyte imbalance
? Insertion of nasogastric drainage tube
? Broad-spectrum antibiotic therapy
? Analgesia ? Vital system support
Operative treatment of cause when appropriate with peritoneal debridement /lavageS