1. Peritonitis by prof/GOUDA ELLABBAN SUEZ CANAL UNIVERSITY
/EGYPT
2. Topics peritonitis Intra-abdominal abscess
3. Anatomy of peritoneum Parital peritoneum Visceral peritoneum
Male close peritoneum Female open peritoneum Abdominal wall
peritoneum
4. Peritonitis is an inflammation (irritation) of the
peritoneum, the membrane that lines the wall of the abdomen and
covers the abdominal organs. Definition :-
5. Etiology Causes of peritonitis Perforation of bowel
Chemically irritating material
10. 0 25 50 75 100 Gram -ve bacteria E-coli K pneumoniae
Pseudomonas species Proteus species Streptococcus species
Staphylococcus species Anaerobic species Comman organisms leading
to primary pertonitis
11. Acute peritoneal infection resulting GI perforation
Secondary peritonitis:-
12. Source Causes Esophagus Boerhaave syndrome Malignancy
Trauma (mostly penetrating) Iatrogenic* Stomach Peptic ulcer
perforation Malignancy (eg, adenocarcinoma, lymphoma,
gastrointestinal stromal tumor) Trauma (mostly penetrating
Iatrogenic* Duodenum Peptic ulcer perforation Trauma (blunt and
penetrating) Iatrogenic* Biliary tract Cholecystitis Stone
perforation from gallbladder (ie, gallstone ileus) or common duct
Malignancy Choledochal cyst (rare) Trauma (mostly penetrating)
Iatrogenic* Common Causes of Secondary Peritonitis
13. Source Causes Small Bowel Ischemic bowel Incarcerated
hernia (internal and external) Closed loop obstruction Crohn
disease Malignancy (rare) Meckel diverticulum Trauma (mostly
penetrating Larg bowel Ischemic bowel Diverticulitis Malignancy
Ulcerative colitis and Crohn disease Appendicitis Colonic volvulus
Trauma (mostly penetrating) Iatrogenic Common Causes of Secondary
Peritonitis
14. Source Causes Pancreas Pancreatitis Trauma (blunt and
penetrating) Iatrogenic* Uterus, salpinx, and ovaries Pelvic
inflammatory disease (eg, salpingo-oophoritis, tuboovarian abscess,
ovarian cyst) Malignancy (rare) Trauma (uncommon) Common Causes of
Secondary Peritonitis
15. This is an acute or chronic inflammation (irritation and
swelling) of the peritoneum (lining of the abdomenal cavity) that
occurs in people receiving peritoneal dialysis. associated -
Dialysis peritonitis
16. The cause of dialysis-associated peritonitis may be the
introduction of bacteria into the peritoneum by the dialysis
procedure. Skin bacteria are the most common organisms causing
infection. Incidence is about one infection for every 15 months of
peritoneal dialysis.
17. Treatment typically involves surgery and antibiotics. In
cases associated with peritoneal dialysis, antibiotics may be
infused through the dialysis catheter, but if the infection is
severe, the catheter itself must often be removed. Treatment
18. Intra abdominal abscess localized peritonitis Definition :-
collection of pus walled-off from rest of peritoneal cavity by
inflammatory adhesions and viscera
19. Number of bacteria exceed hosts ability to terminate
infection complication may perforate leading to diffuse bacterial
peritonitis
20. Classification of intra abdominal abscess Pelvic abscess
Sub phrenic abscess Mid abdominal abscess Intra abdominal
abscess
21. Sub phrenic abscess 35% are right sided abscess 25% are
left sided abscess 20% are multiple abscess Etiology :- Direct
contamination after surgery . Local diseases or injary . Mortality
rate is 25% to 40% Causes of death :- Uncontrolled infection
Malnutrition Prolong hospitalization pulmonary embli nasocomal
infection
22. Mid abdominal abscess Between transverse colon and pelvis
Right lower quadrant abscess Left lower quadrant abscess
23. Pelvic abscess usually complication of :- acute
appendicitis pelvic inflammatory disease colonic
diverticulitis
24. Syptoms abdominal pain dull aching sharp fever chilles loss
of appetite nausea vomiting inability to pass gas or feces
25. Signs toxic ill looking tachypnea tachacardia hypotension
abdomen generlized gaurding rigidity tenderness all over positive
rebound absent peristalsis
27. Investigation 1:-CBC :- leukocytosis 2:-RFT 3:-septic work
up 4:-peritoneal fluid sample for chemistry 5:-plain film of
abdomen 6:-ultrasonography 7:-computed tomography
28. Treatment 1:- control infection 2:- purge bacteria and
toxin 3:- maintain organ system function 4:- control inflammatory
process
29. Medical treatment 1:- systemic antibiotic therapy 2:-
intensive care with hemodynamic, pulmonary and renal replacement
NPO, IVF, Foly catheter 3:-nutrition and metabolic support
4:-inflammatory response modulation therapy
30. Treatment early control of septic source is mandatory and
can be achieved by operative and non opreative means including
percutanous drainage of abscess and percutanous and endoscopic
stent placement
31. Treatment operative mangment 2 principles :- 1:- early and
definitive source control 2:- purging of bacteria and toxin from
abdominal cavity second look operation = sever sepesis
32. Laparoscopy initial laparoscopic examination of abdomen can
assist in elemination of etiology peritonitis diagnostic,
therapeutic
33. Primary peritonitis prognosis the overall mortality rate of
pateints with SBP may exceed 30% if diagnosis and treatment are
delayed less than 10% in fairly-well compensated patients with
early therapy recurrant episodes eithin 1 year represent 70% of
patients the mortality rate approaches 50% long-term antibiotc
prophlaxi decresed to less than 20%
34. Secondary peritonitis prognosis mortality rate less than 5%
in simple abscess and uncomplicated SP more than 30-50% in sever
infection greater than 90% with quadruple organ failure