Rapid care, in which surgery may serve a diagnostic or definitive function
If signs and symptoms, and other tests, cannot fully confirm the diagnosis, the team may sometimes withdraw fluid from the abdomen through a needle to examine it for infection in the pathology laboratory. If the team suspects bleeding in the abdomen, such as from trauma, and cannot confirm this through radiologic imaging (ultrasound or CT) or needle biopsy, it may perform a procedure in which a catheter is inserted through an incision to aspirate fluid from the abdomen (diagnostic peritoneal lavage). These steps may also be useful in identifying the bacteria or other infectious organisms causing an infection, so that the most appropriate antibiotic therapy can be applied.
In addition, to find the possible source of the inflammation, the team may sometimes use videocapsule endoscopy, a newer, non-intrusive procedure in which the patient swallows a miniature camera about the size of a vitamin pill that takes and transmits images of the intestine as it travels the gastrointestinal track and is eventually expelled. This can give the team specific information on locations of bleeding or infection in the small intestine that can cause peritiontits. Specialists in Aria's Division of Gastrointestinal Disease are experienced in offering such testing and evaluation, and in assisting the team in seeking conservative, noninvasive means of treating these conditions.
Patients with confirmed peritonitis usually receive intravenous fluids to prevent dehydration and loss of electrolytes. They may also require intravenous feeding as well, so that normal digestive function will not be required during treatment and healing.
Typically, the medical team will administer antibiotics as soon as possible, sometimes infusing them directly into the patient’s intraperitioneal area through a catheter inserted into the abdominal area. Drug therapy often consists of high doses of multiple, powerful, antibiotic drugs.
But often the surgeon will perform emergency surgery for peritonitis, especially if appendicitis, a perforated peptic ulcer, or diverticulitis is thought to be the cause of the infection. The only complete means of diagnosis for peritonitis is surgery that serves an exploratory function; often, the operation also serves as primary treatment.
The surgical team will examine the abdominal organs, flush out the abdominal space and fluid, and repair any perforations or other anatomical damage that may be the basis of the peritonitis. The surgery will serve to remove the source of infection, such as an inflamed appendix, or to repair a tear in the walls of the gastrointestinal or biliary tract. Such surgical repairs are significant operations, performed with the patient under general anesthesia and requiring recuperation in the hospital afterwards.
Note that if the team believes that the cause of the peritonitis is something other than a tear or rupture – that is, due to such causes as pancreatitis, pelvic inflammatory disease, or a spontaneous infection in the peritoneum – then treatment focuses on medical therapy, and surgery can be avoided.
The peritoneum is naturally and normally resistant to infection. Thus, after successful surgery or other treatment for peritonitis this membrane can heal and return to normal.