Tokushukai Medical Group

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Digestive System Surgery: Inflammation of Peritoneum

Possible to conduct emergency surgical operation depend on the cause.

Inside wall of belly is covered with a membrane called as peritoneal membrane. Peritoneal membrane has several functions. For example, when virus invades in belly, ascites fluid is produced, and this ascites fluid contains white blood cell. This white blood cell works as protection effect to virus. In case when inflammation is developed by some reason, it is called as inflammation of peritoneum. Depend on the cause of this disease, there is a case where emergency surgical operation is necessary. Classification by range, if inflammation is limited, it is called as limited inflammation of peritoneum, and in case inflammation spread over entire abdominal region, it is called as generalized peritonitis. Generalized peritonitis is common in general. Also, depend on the development period, they are grouped in Acute inflammation of peritoneum and Chronic inflammation of peritoneum.

Common development by perforation of the digestive tract.

There are several causes, but the most of them are digestive tract, such as gastric perforation by gastric ulcer or cancer, gastroduodenal perforation, appendix perforation, large bowel perforation by diverticulitis, constipation or cancer. Liver, gallbladder, and pancreas disease like acute bile duct inflammation perforation or acute pancreatitis, gynecological disorder like ovarian cyst perforation or ectopic pregnancy rupture, and external wound or intra-abdominal abscess, are becomes causes of the disease. Or, cancerous peritonitis where cancer is spread over peritoneal membrane, spontaneous bacterial peritonitis which is common in the patients of cirrhosis of liver or nephrosis syndrome are the causes as well.

Severe writhe in pain.

In case of limited inflammation of peritoneum pain at limited region, and in case of generalized peritonitis pain on entire abdominal region are developed, and occasionally severe writhe in pain may occur. Pain is basically continuous one and these won’t disappear. Also, there may be a case which complicating with vomiting, puke, or abdominal bloating.

Abdominal CT exam is effective.

In blood test, increment of white blood cell or neutrophil, or elevation of CRP which is an indicator of inflammation reaction, are recognized usually. However, for the aged or severely injured patient, there is a case where white blood cell is decreased. The most useful one is abdominal CT exam, from which many information like, accumulation of ascitic fluid, free gas recognized in digestive tract perforation case, position of digestive tract perforation, inflammation change at organs, and infected region. This is an inevitable exam. Also, abdominal ultrasonic exam is a simple and no invasion test so that this may be used together.

Basics of the surgery is handling of the causative disease and pollution processing.

Principle of the treatment is early diagnosis and early surgical operation. Also, pre- and post-operative management becomes very important.

Preoperative Treatment
Depend on the condition at the point, but start infusion solution, detain urethral catheter to secure urine volume. Also, to prevent lung complication by aspiration and to reject alimentary tract contents out, insert the gastric tube in mouth. Oxygen supply and anti-bacteria agent is performed, and in case blood pressure is low, there may be the case where vasopressor is used.
Surgery
Two basic principles for surgery are; treatment for causative disease (infected part) and treatment for polluted inside of belly. Appendix ablation in case of appendicitis perforated peritonitis, perforated part closure method for inflammation perforation at gastric or duodenum, cut-off large intestine including perforated area for bowel perforation, and performs surgical construction of artificial anus. Besides, normally inside of belly is polluted by digestive solution or pus, so that clean completely with enough volume of normal saline. To guide polluted liquid, which is remaining inside even after the operation, out of body, retain tube called as abdominal cavity drain. This drain is the information source of complicating disease like postoperative bleeding or postoperative failure of sutures.
Postoperative entire body management
After the surgery, it depends on preoperative condition but, throughout pre-operation to in operation, intensive care, such as infection (blood poisoning) control, DIC (disseminated intravascular coagulation syndrome) control, Prevention of MOF (Multiple Organ Failure), metabolism and nutrition management, is necessary. Normally, paralyzed condition of intestine continues so that it will take time until ingestion intake becomes possible.

Longer time till surgery, increase higher in death rate.

Longer the time from development of inflammation of peritoneum till surgery, higher the increment of death rate. Large intestine perforation is worse in postoperative than upper alimentary canal like stomach or duodenum.

Take immediate medical check when having strong stomach pain.

In case when pain is coming and going like wave, they are relatively mild, such as bowel inflammation, for the most of them (of course there is an exception), but for the case when pain is continuing and there is no improvement, it is necessary to be careful. In case when inflammation of peritoneum is developed, medical care of some kind including surgery requested case is predominant. If in case person bear off these pains, it turns into serious stage, and may risk the life. It is therefore, when having severe and aggressive belly pain, it is strongly recommended to have medical facility checkup immediately.  

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