Acute suppurative peritonitis

　　①Blunt or penetrating abdominal injury leading to rupture or perforation of abdominal organs. Perforation of acute appendicitis is the most common, followed by perforation of gastric and duodenal ulcers, other conditions include gastric cancer, colon cancer perforation, cholecystic perforation, inflammatory bowel disease, and typhoid ulcer perforation, etc. The most common pathogenic bacteria are Escherichia coli, followed by anaerobic bacilli, enterococci, streptococci, proteobacteria, etc., usually mixed bacterial infections with strong toxicity.

　　②Inflammation of the intestinal and abdominal viscera, such as appendicitis, diverticulitis, necrotizing enterocolitis, Crohn's disease, cholecystitis, pancreatitis, and suppurative inflammation of the female reproductive organs, etc.

　　③Postoperative abdominal contamination or anastomotic fistula.

　　④Mechanical strangulated intestinal obstruction and ischemic intestinal obstruction, such as intestinal volvulus, intussusception, obstructive ileus with intestinal necrosis, mesenteric vascular embolism or thrombosis, etc.

　　⑤Iatrogenic injuries, such as colonic perforation during colonoscopy, bile fistula after liver biopsy or percutaneous liver穿刺bile duct造影, intestinal injury after abdominal puncture, etc.

　　If peritonitis is not treated quickly and effectively, multiple organ failure will occur rapidly. The loss of fluid into the peritoneal cavity and intestines can lead to severe dehydration and electrolyte imbalance, causing the patient to appear with a mask-like expression (Hippocratic facies), and may die within a few days. Adult respiratory distress syndrome may also appear rapidly, followed by renal failure, liver failure, and disseminated intravascular coagulation. The formation of adhesions or bands is a late complication, often causing obstruction in the future.

　　In cases of acute suppurative peritonitis caused by acute perforation of hollow organs, hypotension and shock are common due to peritoneal shock or sepsis. At this time, the body temperature is often lower than normal or close to normal; when the shock improves and acute suppurative peritonitis continues to develop, the body temperature begins to gradually increase. If the primary disease is acute infection (such as acute appendicitis and acute cholecystitis), the body temperature is often higher than the original when acute suppurative peritonitis occurs. In cases of acute suppurative peritonitis, due to the large amount of exudate from the peritoneum, the peritoneum and intestinal wall are highly congested and edematous. The atonic intestinal lumen accumulates a large amount of fluid. In addition to vomiting and water loss, the effective circulating blood volume and total blood potassium content are significantly reduced. Moreover, due to reduced renal blood flow, sepsis is exacerbated, and cardiac, renal, and peripheral vascular function is impaired, patients often have hypotension and shock, tachycardia or inability to palpate the pulse, and may also have thirst, oliguria, or anuria, abdominal distension, and no anal gas passage. Frequent hiccups may occur, and the cause may be that the inflammation has spread to the diaphragm.

　　Early and appropriate treatment of intra-abdominal inflammatory diseases that may cause acute suppurative peritonitis is the fundamental measure for preventing acute suppurative peritonitis. Any abdominal surgery, including abdominal puncture and other procedures, should be performed strictly under sterile conditions. The administration of oral antimicrobial drugs before intestinal surgery can reduce the occurrence of acute suppurative peritonitis.

　　1. Laboratory examination

　　White blood cell count and the proportion of neutrophils increase, or toxic granules may be present.

　　2. X-ray examination

　　The small intestine is commonly distended and shows signs of ileus with multiple small fluid levels; free air under the diaphragm is often visible when gastrointestinal perforation occurs.

　　3. Ultrasound examination

　　It can show the presence of fluid in the abdomen, which is helpful for the diagnosis of the primary disease.

　　4. Diagnostic peritoneal puncture or lavage

　　Peritoneal puncture can determine the primary disease change, clarify the cause, such as when the peritoneal puncture fluid is yellow, turbid, and odorless, sometimes food residue can be aspirated; when acute severe pancreatitis occurs, the aspirate is hemorrhagic, and the amylase content is high. If clotted blood is aspirated from the peritoneal cavity, it indicates that there is injury to the intraperitoneal solid organ. When the intraperitoneal fluid is less than 100ml, peritoneal puncture often cannot aspirate fluid, and a certain amount of physiological saline is injected before re-examination.

　　The diet of patients with acute purulent peritonitis should be light and easy to digest, with more fruits and vegetables, a reasonable diet, and attention to sufficient nutrition. Eat less and more often, avoid eating cold and刺激性 food, and have regular meals; avoid heavy physical labor; keep a pleasant mood; and visit the doctor as soon as possible when there is abdominal discomfort.

　　The principle of treatment is to actively eliminate the primary disease cause, improve the general condition, promote the limitation, absorption, or elimination of peritoneal inflammation through drainage.

　　(One) Non-surgical treatment

　　It is suitable for patients with primary peritonitis and secondary peritonitis with relatively localized inflammation or mild symptoms and good general condition. Specific measures include semi-recumbent position, fasting, continuous gastrointestinal decompression, fluid infusion, blood transfusion, application of antibiotics, sedation, oxygen supply, and so on.

　　(Two) Surgical treatment

　　Indications for surgical treatment:

　　1. Severe primary lesions in the peritoneal cavity, such as abdominal organ injury and rupture, strangulated intestinal obstruction, intestinal necrosis caused by inflammation, intestinal perforation, gangrenous cholecystitis perforation, and peritonitis caused by postoperative gastrointestinal warmth and orifice fistula.

　　2. Diffuse peritonitis is severe without a localized trend.

　　3. Patients generally have poor condition, a large amount of peritoneal fluid, severe intestinal paralysis, or obvious toxic symptoms, especially those with shock.

　　4. After 6 to 8 hours of non-surgical treatment (usually not more than 12 hours), if the peritoneal inflammation and signs do not subside or even worsen.

　　5. Diseases that must be surgically resolved due to primary diseases, such as appendiceal perforation and duodenal and jejunal perforation.

　　Surgical treatment methods:Specific measures include treating the primary disease, cleaning the peritoneal cavity, and ensuring adequate drainage.