2.3 Peritonitis

Peritonitis is the inflammation of the peritoneal cavity. It is an acute life-threatening condition caused by bacteria or chemical contamination of the peritoneal cavity (Figure 2:5). Neglected chemical peritonitis will progress to bacterial peritonitis. The most serious complication caused by peritonitis is intestinal obstruction, which may results in death. Other complications include abscess formation, bacteremia, respiratory failure, and shock. Elderly patient with peritonitis is at greater risk for developing life-threatening complications.

2.3.1 The major causes of peritonitis include:

Appendicitis
Perforated peptic ulcer
Anastomotic leak following surgery
Strangulated bowel
Pancreatitis
Cholecystitis
Intra-abdominal abscess
Hematogenous spread of infective agents such as typhoid or tuberculosis
Ascending infection: for example, in salpingitis and postpartum

2.3.2 General management of peritonitis:

The management of patients with peritonitis should be started immediately.

Resuscitation: general patient care with intravenous fluids
Naso-gastric tube insertion (NGT)
Antibiotics
Monitoring input and output by catheterization
Surgery to control source of infection and do drainage and peritoneal lavage

2.3.3 Pre anesthetic consideration

Consider the anesthetic management for intestinal obstruction and emergency patient
Aggressive fluid management is essential. The first priority is to restore intravascular volume and perfusion. Initial resuscitation should be with crystalloid and/or colloid to maintain hydration and perfusion.
Insert a nasogastric tube and commence aspirations to reduce pressure within the bowel
Oxygen should be administered in preoperative period especially if hypotensive or with an oxygen saturation of less than 95% on pulse oximetry or arterial blood gas measurement.
Urinary catheter: start hourly measurement of urine output and use to guide fluid therapy.
Give antibiotics

Intra operative care

Consider the intraoperative care for intestinal obstruction

Postoperative care

The same as for care for intestinal obstruction.