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| Acute Peritonitis Secondary to Acute Appendicitis | ||
| Etiology •Peritonitis is most commonly due to bacterial infection of the abdominal cavity •In other parts of the world parasites are a common cause •Chemical peritonitis can be caused by any irritant such as bile | ||
| Pathogenesis •Bacterial contamination of the abdominal cavity usually occurs in one of three ways •The first is spread of infection from an infectious process involving one of the abdominal or pelvic organs such as: acute appendicitis; acute diverticulitis with perforation; or pelvic inflammatory disease •A second common mode of infection is perforation of a viscus such as peptic ulcer disease or a perforating wound •The third common event is transmigration of bacteria through devitalized or necrotic intestine as in intestinal infarction or necrotic tumor, | ||
| Epidemiology •The epidemiology of peritonitis is that of the primary disease | ||
| General Gross Description •Whatever the cause, bacterial infection of the peritoneum initially shows loss of the normal smooth glistening appearance of the peritoneum •This is followed by reddening and a granular appearance to the peritoneal surface •Visable exudate having a plaque-like yellow appearance is then seen •If the peritonitis resolves, a residual opacity and some fibrous adhesions may remain after resolution •The findings both in the acute phase and following resolution will vary considerably depending on the extent of the infection, the organisms involved and host resistance •Examples: | ||
| General Microscopic Description •Bacterial peritonitis will have the usual signs of any pyogenic infection including acute inflammatory exudate, congestion of vessels, and fibrin exudation •The resolving phase may have granulation tissue and the healed phase will have varying degrees of scarring which may form adhesions •Fairly uncommon now are tuberculous infections which will have a typical granulomatous reaction with fibrosis •Examples: | ||
| Clinical Correlation •The common findings are abdominal pain, rebound tenderness which may be localized, laboratory evidence of pyogenic infection, and loss of bowel sounds •Therapy is directed at the causative organism and the underlying condition | ||
| References •Usually discussed under the heading the primary disease Please be patient during transfer. Medline will open in a new window. To return, close the Medline Window Acute Peritonitis Secondary to Acute Appendicitis
| Synopsis by: Martin Nadel, M.D. (TY4400M41000)[383]
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