Limited peritonitis

Limited peritonitis. When the new delimitation of local peritonitis the patient's condition improved, pain gets better temperature decreases, the abdomen becomes softer, it felt painful seal (infiltration). Treatment: strict bed rest, cold on the abdomen, high-fiber diet, sometimes prescribed antibiotics. When renewed events acute peritonitis is an urgent operation. If started resorption infiltrate - apply the heat (heating pad, UHF). With festering infiltrate - opening abscess formed through the abdominal wall, rectum or vagina (see Douglas abscess).

Acute delimited peritonitis. Reasons delimited peritonitis are the same as those diseases that cause and diffuse peritonitis. Delimitation of due process or the slow development of the main disease, when the peritoneum time to delimit the area of infection from other departments of the abdominal cavity, or the increased ability of the peritoneum to the selection and fibrin formation of adhesions. Delimitation of the inflammation may contribute to the availability around the affected organ of adhesions after previously transferred inflammation. Changes effusion and all stages of inflammation have the same sequence, as at spilled P., unto this happens on a small delimited area of the abdominal cavity. In this form P. a large part of the peritoneum remains unchanged, so the clinical manifestations and developing complications are much less pronounced.
The clinical picture and symptoms. The first period is characterized by phenomena development of local peritonitis; pain can be observed around the abdomen, nausea, vomiting, fever, abdominal swelling. However, these phenomena do not cause severe obsp changes. Color and facial expression patient changed little pulse Ochsen, good filling. Breathing is calm, deep. Cyanosis not. The temperature is subfebrile. Palpation of the abdomen can be defined infiltration, whose density depends on the number of effusion and depth of the process from the abdominal wall. When the surface location of the abscess is possible to determine the fluctuation. Bowel movements are heard, the symptoms of peritoneal irritation nerezko expressed and strictly localized. During the transition delimited., in purulent or putrid again showing symptoms of inflammation. The temperature becomes hectic, accompanied by chills, heavy sweating. In the blood increases the number of leukocytes (up to 20 000-30 000), observed changes the formula of white blood left. Local symptoms depend on the localization of abscess (see Appendix, Subphrenic abscess, Douglas abscess). With the progression of the process abscess may increase but remains all the time delimited. However, increasing infiltration and size of the abscess dangerous possibility of a breakthrough pus in the free abdominal cavity with the subsequent development of severe purulent of peritonitis. Possible breakthrough ulcer in a hollow organ that is accompanied by a Department of a large number of pus through the rectum, bladder, vagina, followed by a sharp decrease palpable education, fall of temperature, the improvement of the General condition of the patient.
In some cases, serous or sero-fibrinous P. does not receive the further development and under the influence of conservative therapy reverses its development. Exudate gradually absorbed, and at the site of inflammation are only spikes. The nature and development of local P. largely depend on its causes, extent of organ, virulence of microorganisms, protective properties of the body and of the treatment.
Treatment for distinguished P. strictly individual and must be decided separately in each case. Basically the nature of the treatment depends on the stage of the process. In the initial stage (first 24-48 hours.) the disease is quite difficult to differentiate whether there are limited or unlimited process. It is therefore advisable to operate urgently. When the operation is usually possible to eliminate the source P. the Surgery is completed by the imposition of a deaf seam on the peritoneum.
In the second stage (2-5 days) of disease is usually detected significant infiltration. In this period expedient conservative treatment and waited-the cautious tactics. Patients prescribed a strict bed rest, local cold, quite simply light diet, sometimes antibiotics, follow the intestinal function. If infiltrate will start to decrease, the normalized temperature and blood, begin to "resolving" therapy (heat currents UHF, ultraviolet irradiation, warm microclysters, and so on). In case of transition to the third stage (abstsedirovaniya)that characterized all the signs of purulent fusion tissue and intoxication, resort to surgical treatment, i.e. opening, emptying, tamponade and drainage of the abscess cavity.
The abscess is located in the pelvis, more open and drain through the rectum; in the field of the caecum - through the abdominal wall oblique vnebrachnyi slit; when subphrenic abscess - through the bed of the XII ribs (Century A. Melnikov). Of postoperative complications of the abdominal abscesses should be noted the development of fecal fistula, purulent lymphangitis and lymphadenitis of the abdominal cavity with a possible formation of secondary metastatic ulcer. Quite often there is a "sympathetic" pleurisy, which may be transferred to empyema. The prognosis for life in a delimited P. in most cases favourable.