Peritonitis

Clinical Description

• Refers to inflammation of the peritoneum.
• Possible Causes: appendicitis, pancreatitis, acute cholecystitis, bowel obstruction or perforated peptic ulcer.

Signs and Symptoms

• Rebound tenderness, guarding, rigidity of the abdominal wall. The patients may also present in septic shock if there is a bowel perforation, appendiceal rupture or cholangitis.

Investigations

• Full blood count
• Group and save
• Amylase and lipase (if pancreatitis suspected)
• Abdominal x-ray (supine and erect) if obstructive causes suspected
• Abdominal ultrasound – if pancreatitis, appendicitis, cholecystitis suspected

Treatment

• Intravenous fluids, analgesia, NPO and insert nasogastric tube
• IV antibiotics: Only indicated for appendicitis, cholecystitis and bowel obstruction with perforation.
• Do not prescribe antibiotics for pancreatitis or bowel obstruction without perforation.
• IV Ceftriaxone 2g 24 hourly for 5-7 days
• IV Metronidazole 500mg 8 hourly for 5 – 7 days

Surgery:

• Indicated in all patients with peritonitis, large bowel obstruction, adhesions and small bowel obstruction after failed conservative management, appendicitis (with or without rupture) and perforated peptic ulcers.
• Indicated for all bowel obstruction due to adhesions or other causes if full blood count shows a leucocytosis.

Complications and Referral Criteria

• if there is no expertise available.
• If the patient is operated and develops complications and requires ICU or re – operation.
• For cholecystitis if no improvement after course of antibiotics.