Definition

Inflammation of the peritoneum.

Etiology

It may be primary or secondary.

Primary Peritonitis

This is of very rare occurrence. When it does occur, it probably develops from cold or exposure, or from a rheumatic state of the body. Not having seen a case of the kind, I can do no more than mention the fact that primary inflammation is recognized by most authorities. I have seen a great many cases of peritonitis, but always of secondary origin.

Secondary Peritonitis

This inflammation is an extension of other inflammations. Diseases of any of the viscera--of the chest, abdominal cavity, and pelvis--may end in peritonitis. Diseases of the liver, with abscess or simple inflammation, may extend to the peritoneum. Gallbladder diseases, malignant diseases of any part of the abdominal cavity, or of the thoracic or pelvic region, may extend to the peritoneum. Ulceration of the stomach, ulceration of the bowels, colitis, muco-colitis, appendicitis, typhlitis, ovarian and uterine inflammations, septic inflammation of the uterus following childbirth or abortion, may extend to the peritoneum. External wounds of the abdomen may by ulceration perforate the peritoneum. Abscesses in the cecal region, or the region of the appendix, will sometimes break into the peritoneum. This means fatal peritonitis, unless the case is operated upon at once, and the cavity thoroughly cleansed and drained. Perforating ulcer of the stomach and duodenum will cause fatal peritonitis. There is no hope for such cases, unless the peritoneum is opened, and thoroughly cleansed and drained.

Symptoms

Inflammation of the peritoneum is ushered in by a chill or chilly feeling. In severe cases the chill amounts to a rigor, with intense pain in the abdomen and aching in the back; in fact, aching all over the body.

In low forms of typhoid fever, where the perforation has occurred after the system has become thoroughly toxemic and the brain dulled by the toxins, the symptoms may develop so insidiously that a fatal state will be evolved before the dangerous condition of the patient will be suspected. However, the watchful physician will observe a swelling of the abdomen, which is a distention of the peritoneal cavity. In other words, tympanitis must be distinguished from gas in the bowels. Both of these distend the abdomen, but there is a vast difference in the two cases. Where tympanitis exists, it means infection of the peritoneum, and, if it is the result of perforation, death will result very soon--within a few hours. In septicemia, following childbirth or abortion, intense pain in the abdomen, quick pulse, flushed face, preceded by a rigor, mean a fatal case, unless it is quickly comprehended and the right treatment used immediately.

Treatment

Inasmuch as peritonitis is secondary to a primary disease, it is necessary to know what the primary disease is. The treatment must be directed to the correction of that disease. Of course, in cases that are rapidly fatal, like perforating ulcer, it is too late to do anything for the primary disease, and all the remedies that can be used must be directed to correcting the secondary disease, which is, peritonitis, As suggested before, if there has been a perforation, the peritoneum must be opened, cleansed, and drained.