What can you eat after peritonitis surgery? Peritonitis. postoperative complications. Informative diagnostic methods

Called inflammation of the peritoneum. This condition is extremely dangerous for the body, as it disrupts the functioning of all vital organs. Acute peritonitis requires emergency medical care, otherwise it can lead to death within a short time.

Peritonitis can be primary or secondary. Primary peritonitis abdominal cavity It is rare (more often in children) and is caused by damage to the peritoneum by microorganisms that penetrate hematogenously, lymphogenously or through the uterine (fallopian) tubes. Secondary peritonitis occurs as a result of the spread of infection from various organs of the abdominal cavity when they are inflamed, perforated or damaged.

Causes of peritonitis

Peritonitis develops when exposed to an infectious (less commonly viral) agent. The peritoneum does not have its own protective capabilities, inflammation spreads quickly, and a huge amount of toxins are produced that quickly poison the entire body.

Pathogenic microorganisms most often enter the peritoneum from internal organs, which for some reason (trauma, surgery, perforation) lost their tightness, and their contents entered the abdominal cavity, causing inflammation, suppuration, and decay there. Sometimes the cause of peritonitis lies in the intracavitary factor.

Among other causes of peritonitis, intestinal dysfunction plays an important role. Different kinds intestinal obstruction in its final stage with developed intestinal necrosis, acute pancreatitis, thrombosis of mesenteric vessels and perforation of tumors of the gastrointestinal tract, gynecological diseases can cause peritonitis.

From a clinical point of view, alcoholic peritonitis is interesting, the pathogenetic cause of which may lie in Mallory-Weiss syndrome, in a toxic perforated ulcer and other conditions. This type of peritonitis is interesting in that it very rarely causes typical or even alarming symptoms, leading to death or serious complications.

Classification of peritonitis

Peritonitis can be primary or secondary.

Primary, also known as idiopathic or viral peritonitis, occurs extremely rarely, as a result of a primary infectious lesion of the abdominal organs and peritoneum. In the case of viral peritonitis, the infection penetrates the peritoneum hematogenously, or through the lymphatic vessels, and occasionally through the fallopian tubes. Viral peritonitis accounts for no more than 1% of all cases of the disease.

Depending on the reason, there are:

• Infectious peritonitis;
• Perforated peritonitis;
• Traumatic peritonitis:
• Postoperative peritonitis.

According to the nature of the inflammatory exudate:

• Serous peritonitis;
• Purulent peritonitis;
• Hemorrhagic peritonitis;
• Fibrinous peritonitis;
• Gangrenous peritonitis.

By degree of distribution:

• Local peritonitis;
• Generalized peritonitis;
• General (total) peritonitis.

By localization:

• Limited (enclosed) peritonitis;
• Diffuse peritonitis.

By traumatic factor:

Acute diffuse peritonitis in most cases develops as a complication of various diseases of the abdominal cavity - perforated ulcer of the stomach, intestines, purulent appendicitis, thrombosis of mesenteric vessels, liver abscess, etc. The causative agent of the inflammatory process in the peritoneum is intestinal microflora: E. coli in combination with streptococci, staphylococci, dysentery bacilli.

In accordance with the etiological factors, the following forms of the disease are distinguished:

• perforated diffuse peritonitis - associated with perforated ulcers of the stomach, duodenum, large and small intestines;
• biliary peritonitis- occurs as a result of perforation of the gallbladder, and in some cases without it;
• septic peritonitis - postpartum.
• pneumococcal peritonitis - occurs with pneumonia, in patients with severe nephritis, etc.
• postoperative peritonitis;
• traumatic peritonitis - associated with mechanical injuries, wounds with cold steel or firearms.

A constant symptom of acute general peritonitis is pain. Severe pain forces the patient to go to bed. They sharply intensify with the slightest movement, coughing, or shaking. The patient's face is pale, cold sticky sweat appears on the forehead, arterial pressure falls, the pulse becomes threadlike. In the future, intense pain may subside, especially during the period of accumulation of exudate in the abdominal cavity. The passage of feces and gases stops, and there is no peristalsis. In this case, vomiting and persistent hiccups are observed. IN early dates from the onset of the disease, the vomit contains food debris. In advanced cases of the disease, vomiting may become fecal in nature.

Acute purulent peritonitis

The causes of acute purulent peritonitis can be:

• An inflammatory disease of any of the abdominal organs (acute appendicitis, cholecystitis, strangulated hernia, inflammation of the internal genital organs in women, etc.), in which the infection spreads from the main focus to the peritoneum.
• Perforation of abdominal organs (perforated gastric ulcer, perforation of typhoid ulcer of the small intestine, etc.), as a result of which infected contents spill into the abdominal cavity and cause peritonitis.
• Injuries to the abdominal organs, which include not only penetrating wounds of the abdominal wall and abdominal organs, but also some blunt (closed) injuries to these organs, such as the intestines. In both of these cases, pyogenic microbes penetrate the abdominal cavity and cause the development of an acute purulent inflammatory process in it.
• Hematogenous (i.e., through the bloodstream) spread of infection to the peritoneum from some distant inflammatory focus, for example, with tonsillitis, osteomyelitis, sepsis, which, however, is very rare.

Thus, peritonitis is always a secondary disease, most often occurring as a complication of any inflammatory process, perforation or damage in the abdominal cavity. That is why, in case of inflammation of the peritoneum, one cannot limit oneself to the diagnosis of “peritonitis”, but it is necessary to establish its primary source, which in fact is the primary disease, and peritonitis is only its complication. True, this is often possible only in the initial stage of peritonitis or during surgery.

Biliary peritonitis

The cause of biliary peritonitis is most often acute inflammation of the gallbladder, usually caused by strangulation of the stone and the presence of a virulent infection, gallbladder increases greatly, and the bile contains flakes or pus and is dirty yellow or gray. The disease is often complicated by acute cholangitis, due to the spread of infection to the bile ducts. Bile may leak from the bladder bed. Increased pressure in the bile ducts, for example due to an unremoved stone in the common bile duct, increases the flow of bile, the accumulation of which around the bile ducts contributes to the development of their stricture.

The severity of symptoms depends on the degree of spread of bile throughout the abdominal cavity and its infection. The entry of bile into the free abdominal cavity leads to severe shock. Bile salts chemically irritate the peritoneum, which causes exudation of large volumes of plasma into the ascitic fluid. The outpouring of bile is accompanied by severe diffuse pain in the abdomen. On examination, the patient is motionless, the skin is pale, low blood pressure, persistent tachycardia, board-like rigidity and diffuse pain on palpation of the abdomen are noted. Intestinal paresis often develops, so biliary peritonitis should always be excluded in patients with unexplained intestinal obstruction. After a few hours, a secondary infection occurs, which is manifested by an increase in body temperature against the background of persistent abdominal pain and soreness.

Peritonitis with appendicitis

Late admission of patients and late diagnosis are the most common causes of complications in acute appendicitis. In the first two days, inflammation of appendicitis is characterized by the absence of complications; the process usually does not extend beyond the appendix, although destructive forms and even perforation can be observed, especially often in children and the elderly. On days 3-5 the following usually occur: perforation of the appendix, local peritonitis, thrombophlebitis of the veins of the mesentery of the appendix, appendiceal infiltrate. After 5 days the following are observed: diffuse peritonitis, appendiceal abscesses, portal vein thrombophlebitis - pylephlebitis, liver abscesses, sepsis.

Inflammation of the appendix develops into inflammation of the peritoneum in 10-15% of cases. It is precisely this development of events that doctors are afraid of, and it is for this reason that they try to be careful with pain in the abdominal area. The difference between the two diseases is that the signs of inflammation of the peritoneum are more pronounced. They are to some extent similar to the signs of appendicitis, but appear with greater force, so in this case doctors have much less doubt about the diagnosis.

Peritonitis after surgery

Peritonitis is a common and serious complication after surgery on the abdominal organs. The cause of its occurrence is most often: failure of anastomotic sutures, duodenal stump, destructive changes in the abdominal organs (acute pancreatitis, necrosis of the stomach or intestinal wall with an incorrect assessment of their viability, perforation of acute ulcers, acute mechanical intestinal obstruction, etc.), infection of the abdominal cavity during surgery or its inadequate sanitation in those operated on for peritonitis.

There is no universal clinical picture of postoperative peritonitis. The difficulty in diagnosing such a complication lies in the fact that the patient has undergone surgery and is already in serious condition, is being intensively treated with medications, including antibiotics, hormones, and is receiving painkillers. The situation becomes more complicated if the patient was operated on for peritonitis (for example, peritonitis that occurred after perforated appendicitis or perforated gastric ulcer, duodenal ulcer). Here it is fundamentally important to distinguish newly emerging postoperative peritonitis from existing (ongoing) peritonitis for which the patient was operated on. Diagnosis of postoperative peritonitis is especially difficult in elderly, malnourished patients with a severe course of the underlying or concomitant disease.

The main thing in the diagnosis of postoperative peritonitis is the early detection of this complication before the development of classic, pronounced symptoms, starting with "Facies Hyppocratica", "board-shaped abdomen", including numerous symptoms of peritoneal irritation, when peritonitis becomes widespread (spread) and passes in its development from the phase absence of signs of sepsis during the sepsis phase.

There are no absolute signs to recognize the onset of peritonitis in the postoperative period. Therefore, much depends on the correct organization of dynamic monitoring of the patient in the postoperative period using clinical and laboratory tests that reveal the progressive increase in endogenous intoxication.

Symptoms of peritonitis

Inflammation of the peritoneum is roughly indicated by an increase in the torso, strenuous walking, and a sudden deterioration in the condition of diseases of the abdominal organs.

Acute peritonitis is a generalized disease that occurs with high fever and very high leukocytosis (100 thousand cells or more per 1 mm3). The abdomen is tucked up, tense and painful. Urination and defecation are impaired and often absent. Sometimes vomiting, tenesmus, and rapid, shallow, chest-type breathing occur. The eyes are sunken, the mucous membranes are red, the capillary refill rate is over 2 s. The pulse is rapid, small in filling, even thread-like. The fluid aspirated during laparocentesis is cloudy, serous, purulent or bloody, containing fibrin flakes.

With chronic peritonitis, all of the above signs may not be detected. The animal is apathetic, drowsy, the belly is somewhat enlarged and saggy. Therefore, chronic peritonitis is often diagnosed only during laparotomy (opacity of the peritoneum, thickening, plaque, pinpoint bleeding).

But the blood status is indicative for both courses of peritonitis (accelerated ESR, leukocytosis with a hyperregenerative shift of the nucleus to the left until the appearance of young and young cells).

Acute peritonitis has several phases of development:

• The reactive phase lasts from 12 to 24 hours;
• Toxic phase, duration from 12 to 72 hours;
• The terminal phase occurs after an interval of 24 to 72 hours from the onset of the disease and lasts several hours.

Thus, acute peritonitis can be fatal within 24 hours of the onset of the disease.

Treatment of peritonitis

Peritonitis requires urgent surgery. The consequences of treatment directly depend on the urgency of the surgical intervention. The operation consists of removing the source of inflammation, sanitizing the abdominal cavity, and draining it. At the same time (as well as in the postoperative period), the water and electrolyte balance, the functions of organs and systems, damage to which is inevitable during peritonitis, is restored.

After the operation, antibiotics and massive infusion therapy are prescribed, aimed at restoring immunity, gastrointestinal functions, and preventing complications.

General principles of treatment of peritonitis:

• possible earlier elimination of the source of infection during surgery;
• evacuation of exudate, washing of the abdominal cavity with antibacterial drugs and adequate drainage of it with tubular drainages;
• elimination of paralytic intestinal obstruction by aspiration of contents through a nasogastric tube, decompression of the gastrointestinal tract, and use of medications;
• correction of volemic, electrolyte, protein deficiencies and acid-base status with the help of adequate infusion therapy;
• restoration and maintenance of kidney, liver, heart and lung function at an optimal level;
• adequate antibiotic therapy.

Appendix - This is an extension of the cecum, and its inflammation is called appendicitis. It can be caused by bending of the appendix due to its excessive mobility (often occurs in children), blockage of its lumen with feces and undigested particles, infections, abdominal injuries and inflammatory bowel diseases.

The only treatment for this disease is surgical - removal of the appendix. The most common conventional surgical procedure is traditional appendectomy , in which the appendix is ​​removed through a regular incision. Endoscopic surgery is used less frequently, but provides less blood loss and trauma because a small incision is made.

Inflammation of the appendix that is not diagnosed in time and not eliminated can cause serious complications, which include appendicular infiltrate And peritonitis . In case of appendiceal infiltrate, when the inflammatory process involves not only the appendix, but also adjacent formations (small intestine, omentum, cecum), conservative treatment is first carried out in a hospital setting, and after resorption of the infiltrate after 2 months, planned appendectomy .

The formation of infiltrates is determined by the individual reaction to the source of inflammation in appendicitis. In some patients, the inflammatory-destructive process is delineated (in the form of an infiltrate), while in others, a diffuse peritonitis (inflammation of the peritoneum). Peritonitis occurs in destructive forms of appendicitis, and is observed in case of untimely treatment, in elderly people and those with intestinal pathology. Its development complicates the course of the operation; in case of peritonitis, the intestines and abdominal cavity are sanitized, and drainage is applied for constant outflow of discharge. More serious, complex treatment is prescribed in the postoperative period.

The recovery period lasts from the moment of surgery until the sutures are removed. At this time, the restoration of body functions (defecation, urination) and the condition of postoperative sutures are monitored. Recovery is different for everyone, but it is faster in younger and thinner patients. Its duration increases if it was difficult appendectomy . During this period, nutrition plays an important role at all stages.

In the postoperative period, a zero or surgical diet is prescribed. These are three gradually prescribed diets that make up a single nutrition system in the first week after surgery.

The purpose of prescribing a zero diet is:

• maximum unloading of the digestive organs and their sparing;
• warnings .

Nutrition after appendectomy

It is characterized by maximum mechanical and chemical sparing of organs, since the patient is allowed to consume only liquid, semi-liquid, pureed and jelly-like dishes. Salt restrictions are being introduced. The diet includes light and easily digestible foods, low in protein, fat and carbohydrates, the amount of which gradually increases throughout the week. Accordingly, the power consumption also increases.

So, they start eating with a diet that contains only 5 g of protein, 150 g of carbohydrates and 15 g of fat. From the third day, the diet expands and already includes 40 g of proteins, the same amount of fat, 250 g of carbohydrates, and the amount of salt increases slightly. And after another 2 days, the patient can already consume up to 90 g of proteins, 70 g of fats and the physiological norm of carbohydrates (350 g). During these days, it is recommended to drink plenty of fluids. Nutrition after surgery involves frequent meals, first in small portions (100-200 g in adults and 50 g in children) with a gradual increase in volume up to 300 g per meal.

Start eating with Diets No. 0A . Only liquid and jelly-like dishes (jelly) are allowed. Seven to eight meals a day are recommended. On a daily basis it looks like this:

First day

• strained compote;
• sweet rosehip decoction;
• weak sweet tea;
• weak meat broth;
• rice broth;
• berry jelly (strained);
• fresh juices, diluted 2 times with water (50 ml per serving).

Consumption of sour cream, whole milk, pureed foods, grape juice and vegetable juices, and carbonated drinks is prohibited. Vegetables and milk can cause bloating, which is extremely undesirable after intestinal surgery. Further meals will be organized within Table No. 0B , which is prescribed for 2-4 days (depending on the patient’s condition). At one time, the patient can eat 350-400 g of food. Meals six times a day.

Second and third days

• liquid and mashed porridges ( cereals, rice, buckwheat) in meat broth or broth diluted with water;
• slimy cereal soups;
• weak meat broths with the addition of semolina;
• steam omelettes and soft-boiled eggs;
• steamed meat and fish soufflés and purees from low-fat meat and fish;
• cream (100 g, added to dishes);
• berry jellies and mousses from non-acidic berries.

Fourth and fifth days

• pureed soups;
• pureed fresh cottage cheese (add cream or milk);
• meat, fish and chicken, ground in a meat grinder (added as minced meat to dishes);
• curd dishes (steam);
• 100 g white crackers;
• dairy products;
• pureed zucchini, potatoes and pumpkin;
• baked apples;
• pureed milk porridges;
• fruit and vegetable puree;
• tea with milk.

Meals after peritonitis does not differ from the above, the only difference is that the transition from one version of the surgical diet to another is more delayed in time due to the serious condition of the patient. After completing three options of zero diets, the patient, depending on the state of health, is transferred to a standard or No. 1 surgical . It differs from Diet No. 1 in that it includes weak meat and fish broths and limits milk consumption. Nutritional issues are discussed with the attending physician.

The diet after removal of appendicitis should be followed for a month, and in case of complications and concomitant diseases of the gastrointestinal tract, or more. These questions are discussed with the doctor. During this time, food should be easily digestible.

• small and frequent meals;
• lean fish, chicken or beef, which is prepared by boiling;
• complete nutrition based on protein content, vitamins and minerals;
• limit heavy fats, avoid fatty meats, smoked meats, any sausages, mayonnaise, hot sauces;
• exclude foods that promote fermentation and gas formation (coarse vegetables, legumes, any varieties of cabbage, carbonated drinks).

After surgery for appendicitis, the patient for 3 months should not:

• ignore wearing a bandage;
• perform unacceptable physical activity.

Within 1.5 months, muscle fusion occurs and the risk of hernia remains, therefore, after removal of the appendix, heavy lifting is prohibited. But daily slow walking (up to 2-3 km per day) is indicated as it prevents the appearance of adhesions.

Authorized Products

• Puréed soups are prepared in water or weak meat broth made from oatmeal, buckwheat, semolina, and rice. You can add an egg-milk mixture, a small amount of cream (50-100 ml) and butter (5 g) into soups. From the fourth day, boiled chopped meat, after 7-9 days meatballs.
• White crackers 75-100 g per day.
• Meat and poultry are first prepared in the form of a soufflé, a little later in the form of cutlets and quenelles; a month after the operation, you can eat lump meat.
• Fish is also prepared in the form of a soufflé, twisted boiled minced meat, and then in the form of cutlets, meatballs and quenelles. To prepare dishes choose lean fish(cod, hake, pike, whiting, pollock, ice).
• Porridges are prepared pureed and semi-liquid, adding milk and butter.
• From the fourth, potato, pumpkin, carrot, zucchini and beet puree are introduced, for the preparation of which cream or milk and butter are used. If desired, vegetable dishes can be replaced with vegetable baby food.
• Eggs are consumed daily (soft-boiled or steamed omelet).
• Milk is used as an addition to cereals, in tea, you can eat pureed cottage cheese every day, adding milk or cream. Cream is also added to soups or tea. The consumption of these products in their natural form is not permitted due to the possibility of developing flatulence .
• The berries are used to make jelly and jellies. Apples are consumed only baked or stewed, and only towards the end of the month can they be consumed fresh.
• Honey and sugar (40-50 g).
• Butter (butter) is added to dishes.
• You can drink weak tea with milk and cream, herbal teas, diluted berry juices, rosehip infusion.

Table of permitted products

	Proteins, g	Fats, g	Carbohydrates, g	Calories, kcal
Cereals and porridges
buckwheat (kernel)	12,6	3,3	62,1	313
semolina	10,3	1,0	73,3	328
cereals	11,9	7,2	69,3	366
white rice	6,7	0,7	78,9	344
Confectionery
jelly	2,7	0,0	17,9	79
Raw materials and seasonings
sugar	0,0	0,0	99,7	398
Dairy
milk	3,2	3,6	4,8	64
cream	2,8	20,0	3,7	205
Cheeses and cottage cheese
cottage cheese	17,2	5,0	1,8	121
Meat products
boiled beef	25,8	16,8	0,0	254
boiled veal	30,7	0,9	0,0	131
rabbit	21,0	8,0	0,0	156
Bird
boiled chicken	25,2	7,4	0,0	170
turkey	19,2	0,7	0,0	84
Eggs
chicken eggs	12,7	10,9	0,7	157
Oils and fats
butter	0,5	82,5	0,8	748
Non-alcoholic drinks
mineral water	0,0	0,0	0,0	-
black tea with milk and sugar	0,7	0,8	8,2	43
Juices and compotes
juice	0,3	0,1	9,2	40
jelly	0,2	0,0	16,7	68
rose hip juice	0,1	0,0	17,6	70

Fully or partially limited products

The diet after appendicitis includes exclusion from the diet:

• beans, peas, beans, lentils, cabbage, which cause gas formation and can provoke intestinal colic;
• salt for 2 weeks (or sharply limit);
• for a month or more smoked foods, fried foods, fatty meats, coarse meats, sausages (smoked and boiled), mayonnaise, ketchup and sauces, fatty fish, salted and smoked fish;
• mushrooms (as a difficult-to-digest product);
• carbonated and alcoholic drinks, strong tea and coffee;
• sauces, vinegar, ketchup, mayonnaise and seasonings.

Table of prohibited products

	Proteins, g	Fats, g	Carbohydrates, g	Calories, kcal
Vegetables and greens
vegetables	2,5	0,3	7,0	35
horseradish	3,2	0,4	10,5	56
Cereals and porridges
corn grits	8,3	1,2	75,0	337
pearl barley	9,3	1,1	73,7	320
millet cereal	11,5	3,3	69,3	348
barley grits	10,4	1,3	66,3	324
Bakery products
white bread crackers	11,2	1,4	72,2	331
wheat bread	8,1	1,0	48,8	242
Confectionery
jam	0,3	0,2	63,0	263
candies	4,3	19,8	67,5	453
Ice cream
ice cream	3,7	6,9	22,1	189
Raw materials and seasonings
mustard	5,7	6,4	22,0	162
ketchup	1,8	1,0	22,2	93
mayonnaise	2,4	67,0	3,9	627
ground black pepper	10,4	3,3	38,7	251
chilli	2,0	0,2	9,5	40
Dairy
kefir	3,4	2,0	4,7	51
sour cream	2,8	20,0	3,2	206
curdled milk	2,9	2,5	4,1	53
Meat products
pork	16,0	21,6	0,0	259
Sausages
dry-cured sausage	24,1	38,3	1,0	455
sausages	12,3	25,3	0,0	277
Bird
smoked chicken	27,5	8,2	0,0	184
duck	16,5	61,2	0,0	346
smoked duck	19,0	28,4	0,0	337
goose	16,1	33,3	0,0	364
Fish and seafood
dried fish	17,5	4,6	0,0	139
smoked fish	26,8	9,9	0,0	196
canned fish	17,5	2,0	0,0	88
Oils and fats
creamy margarine	0,5	82,0	0,0	745
animal fat	0,0	99,7	0,0	897
cooking fat	0,0	99,7	0,0	897
Non-alcoholic drinks
black tea	20,0	5,1	6,9	152
* data is per 100 g of product

Menu (Power Mode)

The nutrition menu after surgery reflects a gradual expansion of the diet and amount of food consumed. Of course, in the first week (or more) the food is non-caloric and does not correspond to the physiological norms of a healthy person. However, it is sufficient for a patient who has undergone surgery and is on bed rest. A gradual increase in food load on the digestive organs trains them and prepares them for proper nutrition. Below is the menu by day.

Doctors call appendicitis a disease of the appendix, in which it is necessary to perform surgery as quickly as possible. It is the most common disease of organs in the abdominal cavity. If a person develops acute appendicitis, he needs to be called immediately ambulance. If appendicitis is not treated, peritonitis can develop, a deadly complication. But even in this case it is possible to perform an operation.

Appendicitis is an inflammation of the appendix, that is, the part of the large intestine that is located on the right, in the abdominal cavity. No one still knows what role he plays. Some people think it has some effect on protecting the intestines from certain bacteria. But it is not known exactly why appendicitis occurs. In order for it to arise, two factors are necessary:

1. The presence of certain bacteria in the intestines.
2. The lumen of the appendix becomes blocked, which can happen due to spasms or a foreign body entering the intestine. This is due to the fact that stool can penetrate into that lumen and harden, which contributes to the occurrence of infection. The same reason may be the ingestion of seeds from berries and fruits or seeds.

Signs of appendicitis

Most often they depend on how old the patient is and how the appendix is ​​located. There are several typical signs of this disease.

• Abdominal pain . This is the first and main symptom of acute appendicitis. As a rule, the patient complains of a dull pain in the upper abdomen, then the pain begins in the right side. They are accompanied by a headache and severe weakness, and sometimes the legs hurt.
• Temperature the body rises to 38 degrees, is not very high, but helps to distinguish appendicitis from some other diseases.
• Appears nausea, vomiting . As a rule, along with pain during appendicitis, nausea appears, which soon begins to be accompanied by vomiting, and in children sometimes diarrhea begins.

If a person experiences all these symptoms, then he should not take painkillers, because this may make the disease more complicated.

Operation

The surgical intervention is carried out in such a way that the appendix is ​​cut out from the patient under local anesthesia. If the appendix has not ruptured, then the operation takes about forty minutes, after which stitches are applied. Nowadays, the skin is not always cut, but can be punctured, which will allow the patient to speed up recovery. This is possible if the appendicitis has not ruptured.

If there are no complications, then after a week you can begin your normal activities. The sutures are removed approximately on the tenth day. After this, you can walk, get up, and move as usual. A small scar remains on the abdomen, which may remain red for the first year, and then fade and become less noticeable. After surgery, it is better not to engage in physical activity and limit your sex life.

Diet after removal of appendicitis and peritonitis

During the operation, the appendix is ​​removed, which disrupts the integrity of the intestine, and doctors have to apply stitches. Eating regular food immediately after surgery increases the likelihood that the stitches will come apart. It is clear that the food must be special.

On the first day After the operation, the person is recovering from anesthesia, and he is unlikely to feel like eating. And the intestines need time to start functioning normally again. Therefore, immediately after surgery it is recommended just drink a little water . Depending on the situation, the doctor may allow you to drink broth, rice broth or tea.

On the second or third day doctors allow eat in small portions , about five times a day. Avoid eating foods that can cause gas. and increase inflammation of the sutures. Food can be like jelly and should be taken only warm. Recommended for use chicken broth, yogurt without dyes or additives, zucchini or pumpkin puree, chicken puree, rice broth, mashed potatoes. Sometimes doctors advise consuming foods that contain fiber, for example, baked apples or boiled carrots.

In the first week after surgery it is necessary to normalize the stool. After the first three days, the diet is usually expanded to include foods containing fiber . These include porridge on water prepared from cereals, berries and fruits, prepared steamed vegetables, dried fruits, puree soups, lean meats and fish, butter, dairy products. Main, eat according to the principle of thorough chewing products until their consistency becomes pasty, but not too dry.

Meals should be consumed in small portions, every two to three hours. In addition, you also need drink enough water because otherwise a feeling of discomfort may occur. If there are no cardiac contraindications, you can drink up to ten glasses a day. The majority of this liquid should be plain water.

In addition, it is worth exclude the consumption of foods such as spices, legumes, dairy and fatty foods . The point of this diet is to create the necessary conditions for faster wound healing and improved peristalsis.

After the first week passes, the diet expands further. You can use absolutely any soup made with chicken or vegetable broth, but without frying. You can add onions, beets, zucchini, potatoes, but before consuming it, it is better to put it through a blender.

Mushrooms, omelettes with fish or vegetables, pasta casserole, porridge cooked in water, to which you can add butter, are suitable as second courses. You cannot use additives such as mayonnaise, ketchup, horseradish, mustard and other spices and seasonings.

After a month, you can start using legume products after the patient has undergone surgery. It is not recommended to eat sweets, pastries, baked goods and cakes earlier than a month after. Everything heals completely only after a few months. Therefore, it is necessary to follow a special diet for several weeks, and after that you can begin to eat as the patient is used to. Sometimes your doctor may recommend some other diet, in which case it is better to listen to him.

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Peritonitis is a pathological condition characterized by inflammation of the thin connective tissue membrane (peritoneum) covering the abdominal cavity from the inside.

In most cases, peritonitis occurs as a complication of various surgical pathologies of the abdominal cavity, accompanied by a violation of the integrity of the wall of the large (32% of cases) or small intestine (13% of cases), the vermiform appendix of the cecum (appendix) (3% of cases), stomach/duodenum intestines (18% of cases) with the leakage of the contents of the gastrointestinal tract into the abdominal cavity.

Classification of peritonitis

1. According to the ways of spreading the infection, the following types of peritonitis are distinguished:
2. Primary: caused by the spread of infection through the blood (hematogenous) or lymph (lymphogenous) from distant foci of infection. An example is spontaneous bacterial peritonitis, diagnosed in patients with cirrhosis of the liver, or tuberculous peritonitis in patients with pulmonary tuberculosis;
3. Secondary: occurs as a complication of acute surgical pathology, accompanied by perforation of the hollow organs of the abdominal cavity. The most common cause of secondary peritonitis is appendicitis (K35), perforated gastric ulcer (K25) or duodenal ulcer (K26), diverticulosis (K57), circulatory disorders in the branches of the mesenteric arteries (intestinal infarction, thrombosis of the mesenteric arteries) (K55.0), strangulated abdominal hernia (K46.0), intestinal obstruction caused by intussusception (K56.1) or volvulus (K56.2), acute pancreatitis (K85). Secondary peritonitis may be the result of a surgeon’s mistake made during abdominal surgery (failure of sutures on the intestine, damage to the walls of hollow organs due to negligence). Any penetrating or blunt wound to the abdominal cavity also leads to secondary peritonitis (rupture of the spleen, liver, internal bleeding, knife or gunshot wound);
4. Tertiary: diagnosed in patients with a weak immune system who have serious diseases of other organs and systems (tuberculosis, HIV, AIDS).
5. Classification by stream:
6. Acute peritonitis;
7. Chronic peritonitis.
8. Depending on the presence of infection, there are:
9. Bacterial (microbial) peritonitis;
10. Aseptic/chemical peritonitis. Possible reasons aseptic peritonitis - chemicals (hydrochloric acid of gastric juice), blood, bile flowing into the abdominal cavity. Aseptic inflammation of the serous membrane of the abdominal cavity is possible in patients with systemic connective tissue diseases (rheumatoid arthritis, systemic lupus erythematosus).
11. Classification according to the nature of the exudate:
12. Dry peritonitis (without exudate);

Exudative peritonitis:

Serous;

Fibrinous;

Purulent peritonitis;

Hemorrhagic.

Classification according to the prevalence of peritoneal inflammation:

Local (local) peritonitis (affecting one area of ​​the abdominal cavity);

Widespread/diffused peritonitis (affecting 2-5 areas of the abdominal cavity);

Total (with damage to the entire peritoneum).

Causes of peritonitis

The immediate cause of peritonitis in the vast majority of cases is an infection that causes inflammation. Aseptic peritonitis associated with the leakage of sterile biological fluids into the abdominal cavity is considered such only at the onset of the disease. After some time, infection inevitably occurs.

An example of true aseptic peritonitis is inflammation of the peritoneum in systemic connective tissue diseases caused by an autoimmune process. Surgical treatment in such cases is usually not required.

In most cases, peritonitis is caused by gram-negative and gram-positive intestinal flora.

A specific infection can also cause peritonitis. Most often, chlamydial (K67.0), gonococcal (K67.1), syphilitic (K67.2), tuberculous (K67.3) peritonitis is diagnosed. Chlamydial and gonococcal peritonitis is more typical for women, due to the presence of direct routes of spread of infection from the pelvic organs to the abdominal cavity through the fallopian tubes.

Risk factors for peritonitis

The following pathological conditions and medical procedures increase the risk of peritonitis:

• Ascites, liver cirrhosis;
• Severe diseases of other organs and systems;
• Chronic inflammatory diseases of the pelvis in women;
• Peritonitis in the past in the same patient;
• Surgical and diagnostic interventions in the abdominal cavity;
• Peritoneal dialysis (a procedure used to cleanse the blood of toxins and poisons).

Mechanism of peritonitis

Let's consider the mechanism of peritonitis using the example of appendicitis (inflammation of the vermiform appendix of the cecum).

The peritoneum is a thin connective tissue membrane lining the organs and walls of the abdominal cavity. Constantly produces a small amount of fluid that facilitates the sliding of internal organs, contains a large number of blood vessels and nerves. Normally, the peritoneum and abdominal cavity are sterile.

The cecum, like any other part of the large intestine, contains a huge number of bacteria in its lumen. Under normal conditions, this microflora performs useful functions, participating in digestion, synthesis of vitamins, and supports the immune system. However, when these same bacteria enter the sterile abdominal cavity, they begin to exhibit their pathogenic properties, causing inflammation and intoxication. The situation is complicated by the large area of ​​the peritoneum, through which bacterial waste products and toxins are absorbed.

In the first hours after the onset of appendicitis, inflammation of the appendix is ​​limited to its walls. The pain that occurs during this period is caused by reactive irritation of the nerve endings located in the peritoneum, covering the appendix on all sides. As the disease progresses, inflammation leads to swelling and increased permeability of the walls of the appendix (phlegmonous appendicitis). Peritonitis, which begins at this stage, involves the peritoneum of the appendix, which provokes intense pain in the right iliac region. Surgical removal of the appendix at this stage prevents possible complications in the form of diffuse peritonitis with the transition of inflammation to other areas of the abdominal cavity.

Late seeking medical help provokes gangrenous appendicitis, with necrosis and perforation of the wall of the appendix. The contents of the cecum and transudate enter directly into the abdominal cavity, seeding it with intestinal flora. A change in body position provokes the flow of infected transudate into the subhepatic region and other parts of the abdomen, which leads to the spread of infection. 24 hours after perforation of the appendix, we can talk about diffuse peritonitis, with intestinal paresis (paralysis).

The infectious process leads to activation immune system, massive intoxication of the body and other complications. Without treatment, peritonitis leads to sepsis - blood poisoning that occurs with multiple organ failure, ending in death.

The body's response to infection depends on the state of immunity and health of the patient, the aggressiveness of the infection, and the volume of intestinal contents leaked into the abdominal cavity.

Stages of peritonitis

There are 3 successive stages of peritonitis:

1. Reactive stage: lasts the first day after the onset of pain and is characterized by severe symptoms.
2. Toxic stage: lasts for the next 24-72 hours. Accompanied by an increase in intoxication of the body and a decrease in local symptoms - abdominal pain, tension in the abdominal wall (a period of imaginary well-being).
3. Terminal stage: severe subtotal or total peritonitis with massive intoxication, multiple organ failure, toxic shock and irreversible changes in the body.

Peritonitis in children

Peritonitis in childhood develops faster and is more aggressive than in adults. In newborns and infants, this pathology leads to death in 78% of cases. The situation is complicated by the child’s lack of ability to tell and show in detail what is bothering him and where it hurts. The only signs of pathology in such patients are constant crying, breast refusal, tension in the abdominal wall, heat, blood in the stool. The main cause of peritonitis in children is volvulus, intussusception, and ischemic intestinal infarction.

Peritonitis in the elderly

Unlike children, peritonitis in older people can occur with minor pain and scant symptoms. Pain syndrome is present in only 50% of patients, muscle tension in the abdominal wall is present in only 34%. The reason is the reduced reactivity of the body and age-related changes. Moreover, in older people with diabetes, peritonitis can be virtually asymptomatic. Late seeking medical help due to the absence of characteristic symptoms causes high mortality in patients in this age group.

Symptoms of peritonitis

• Strong sharp pains in the abdomen, positive symptoms of peritoneal irritation;
• Tension of the abdominal muscles (“board” belly);
• Nausea, without or with vomiting;
• Fever (80% of patients with peritonitis have a high temperature with chills);
• Lack of appetite;
• Severe thirst (it is strictly forbidden to give water or food to the patient);
• Frequent loose stools or absence of stools/intestinal gases;
• Rare scanty urination;
• Severe weakness;
• Tachycardia;
• Sticky cold sweat;
• Absence of sounds of intestinal peristalsis.

Diagnosis of peritonitis

Instrumental research methods are used to diagnose the causes of peritonitis and differential diagnosis of diseases that give similar symptoms. They include radiography of the abdomen, ECG, ultrasound of the genitourinary system, liver and biliary tract, pancreas, esophagogastroduodenoscopy (EFGDS). In controversial cases, computed tomography with contrast is used.

Minimum required set of laboratory tests:

• Complete blood test with leukocyte formula to determine leukocytosis;
• Blood test for amylase (if acute pancreatitis is suspected);
• General urine analysis (excluding acute pyelonephritis, which gives similar symptoms);
• Microscopic and bacteriological analysis of transudate obtained during surgery, with culture for sensitivity to antibiotics;
• Blood tests for group and Rh factor;
• Blood test for coagulation (coagulogram, hemostasiogram);
• Blood tests for HIV, RW, hepatitis B and C;
• Blood test for biochemistry.

Treatment of peritonitis

The main method of treatment is surgical. The purpose of surgery is to eliminate the causes that led to inflammation of the peritoneum. For appendicitis, this means removal of the appendix; for a perforated ulcer - removal of the ulcer or radical gastrectomy (resection of part of the stomach); in case of intestinal volvulus, strangulated hernia, in case of ischemic intestinal necrosis - removal of the non-viable part of the organ. Surgery for peritonitis is the only available treatment method that can save the patient’s life.

After eliminating the immediate source of infection, sanitation of the abdominal cavity is performed - peritoneal lavage. During this procedure, antiseptic solutions are poured into the abdominal cavity, which are then evacuated through drains (tubes that drain fluid out).

Preparation for surgery for peritonitis

Preparation for surgical treatment of peritonitis is standard for any abdominal surgery. Includes intensive antibacterial therapy, gastric and/or colon lavage, premedication (the use of drugs that facilitate immersion in anesthesia and prevent complications of anesthesia), measures to stabilize the patient’s condition before surgery.

Medicines and drugs for peritonitis

The basis of drug therapy for peritonitis is antibacterial therapy, the purpose of which is to eliminate the infection. Modern antibiotics from the group of fluoroquinolones, cephalosporins, and penicillins are used (the specific drug is selected based on the results of a microbiological study or empirically).

Complications of peritonitis

Possible complications of peritonitis:

• Formation of an abdominal abscess;
• Intestinal obstruction;
• Adhesive disease;
• Acute thrombophlebitis/thrombosis of the portal vein of the liver;
• Liver abscesses;
• Formation of intestinal fistulas;
• Abdominal compression syndrome (pathological increase in pressure in the abdominal cavity);
• Nosocomial infection.

Correct lifestyle during the recovery period after peritonitis

The consequences of peritonitis and complete recovery of the body last several months. During this time, it is necessary to follow the recommendations of doctors: use a postoperative bandage that prevents the formation of a postoperative hernia, do not lift weights, adhere to a healthy and balanced diet, lead an active lifestyle with dosed physical activity (outdoor walks, walking, breathing exercises, gymnastics).

Eating during the acute period of peritonitis is strictly prohibited (it is prohibited to take any food or liquids). In the early postoperative period, table No. 0 according to Pevzner is prescribed - weak meat broths, juices, jelly, jelly, fruit and berry decoctions. Meals are fractional, frequent, in small portions, 6-8 times a day. Eating rough, hard food is prohibited.

Prognosis for peritonitis

With timely provision of medical care, the prognosis is favorable. The risk of death is less than 5%. The lack of adequate diagnosis and treatment provokes complications in the form of shock, sepsis, multiple organ failure (mortality reaches 50%). The patient's age less than 10 years and more than 65 years is also associated with a greater risk to life.

Prevention of peritonitis

Primary prevention of peritonitis is impossible. Secondary prevention consists of timely diagnosis and treatment of pathologies leading to acute abdomen. In patients with liver ascites/cirrhosis, antibiotic therapy is used as primary prevention of spontaneous bacterial peritonitis.

Content

When severe pain in the abdomen, which does not go away for a long time, you should immediately seek help from a doctor. It is possible that these are the first symptoms of peritonitis - a disease of the abdominal cavity that poses a serious danger to humans. In advanced or severe cases, the disease can even lead to death.

What is peritonitis

If you experience sudden abdominal pain, you should know exactly what peritonitis is and whether it is life-threatening. Local or diffuse inflammation of the thin wall of the peritoneum - peritonitis - is caused by a fungal or bacterial infection that can enter the cavity from the outside or from another part of the body. Inflammation of the peritoneum also occurs as a result of organ trauma. The development of the disease causes disruption of the human body due to severe intoxication.

When pathogenic microorganisms influence the surface of the peritoneum, the connective tissue is capable of producing special substances that stop the process. If the number of pathogenic agents is large, then the abdominal cavity becomes involved in inflammation - a disease occurs. The danger of the disease is that the infection can quickly spread through the bloodstream to vital organs. A common cause of the disease is inflammation of appendicitis. Appendiceal infiltrate is the most severe purulent disease, which often develops in children.

Viral peritonitis

Depending on the causes of inflammation of the abdominal cavity, it is divided into different types:

• traumatic;
• spicy;
• serous;
• purulent;
• infectious and others.

Viral peritonitis - what kind of disease is it? The disease is an inflammation of the abdominal cavity due to infectious primary organ damage. The viral form of the disease allows the infection to spread through the bloodstream. This type is rarely diagnosed, in only 1% of cases. The disease manifests itself clearly in appearance patient. The skin turns pale and there is a loss of strength. Other symptoms:

• nausea;
• vomit;
• intestinal obstruction (paresis);
• absence of feces;
• shallow breathing;
• a dark coating appears on the tongue.

Acute peritonitis

A type of infection of the abdominal cavity is acute peritonitis. The disease is accompanied by local pronounced changes and functional general disorders body. The structure of causes is dominated by perforation of different parts of the digestive tract, destructive appendicitis, and pathology of the small intestine. The surgical route of infection is classified into a separate group: these are patients with postoperative complications and penetrating wounds. Acute peritonitis of the abdominal cavity has the following symptoms:

• severe abdominal pain;
• intestinal paresis;
• nausea;
• dehydration.
• absence of gases;
• dry tongue;
• tachycardia.

Chronic peritonitis

The manifestation of inflammation of the peritoneum in the chronic form is erased. The main causes of the disease are pathologies of the peritoneal organs and complications after surgery. As a rule, chronic peritonitis is a sluggish, but progressive disease that is life-threatening. The patient does not experience muscle tension or acute pain, and the disease can go unnoticed for a long time. In a child, the disease can occur as a complication of appendicitis. The following characteristic features of this form are distinguished:

• increased sweating;
• periodic abdominal pain;
• sudden weight loss;
• constipation

Peritonitis - causes

The main classification of the disease includes primary and secondary forms. In the first type, the disease can be caused by microorganisms that enter the peritoneum through the bloodstream from an infectious focus. At the same time, the integrity of the abdominal cavity is preserved. The secondary type of the disease is accompanied by rupture or damage to all abdominal layers as a result of penetrating abdominal trauma. If peritonitis is suspected based on symptoms, the reasons may be the following:

• pelvic inflammation;
• pancreatitis;
• rupture of the appendix (appendage of the cecum);
• diseases of the digestive tract;
• diverticulitis;
• gallbladder perforation;
• surgical operations in the abdominal cavity;
• in gynecology – genital infections;
• complications after abortion;
• cirrhosis of the liver;
• acute intestinal obstruction.

Peritonitis - symptoms

Inflammation of the peritoneum often begins with acute pain. The sensations quickly intensify when moving or pressing on the affected organ. As a rule, the pain is sudden and its intensity gradually decreases. Other possible signs of peritonitis:

• lack of appetite;
• nausea;
• chills;
• vomit;
• heat;
• bloating;
• Mendel's symptom (stretched smooth muscles);
• difficulty with bowel movements;
• excessive fatigue.

Treatment of peritonitis

If an inflammatory process of the peritoneum occurs, the necessary therapy should be carried out only in a hospital, otherwise negative consequences are possible (hemoperitoneum, or accumulation of blood that can spread throughout the body). Treatment of peritonitis at the first stage involves taking antifungal drugs or using antibiotic injections. The course lasts 2 weeks. Painkillers are used to relieve pain.

Some patients have trouble digesting food and will need to be fed through a tube inserted into the stomach through the nose or through surgery. In some cases, multiple dangerous abscesses (cavities filled with pus) occur in the peritoneum, which will require surgery using ultrasound, which is often performed under local anesthesia.

Diet after peritonitis

After surgery, the patient is fed through a tube - by introducing a nutrient mixture. At the end of the rehabilitation period, the doctor may allow a full diet. The definition of diet depends on the underlying cause of the disease. Meals after peritonitis should be small, frequent and include:

• slimy porridge;
• pureed foods;
• lean meats;
• dairy products;
• jelly;
• yesterday's bread;
• vegetables that do not contain coarse fiber;
• scrambled eggs.

The diet prohibits the use of:

• smoked, salted, pickled products;
• chocolate;
• tea, coffee.

Rehabilitation after peritonitis

In the postoperative period, problems may arise that are associated with normal bowel function, severe pain, and the development of purulent complications. To avoid such troubles and have a favorable prognosis for recovery, rehabilitation after peritonitis is necessary, including:

• hourly assessment of the state of pulse rate, respiration, diuresis, venous central pressure;
• constant monitoring of the patient,
• warming the patient to body temperature;
• infusion therapy with colloid solutions;
• early restoration of intestinal motility;
• ventilation of the lungs for 72 hours;
• administration of glucose solution;
• prevention of pain syndrome.

Video: peritonitis in children

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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