Inflammation of the peritoneum or peritonitis of the abdominal cavity is an extremely life-threatening pathology requiring immediate hospitalization and surgical intervention.
Preoperative preparation
To prepare the patient for surgery, no more than 3 hours are allowed - during this time the doctors conduct intensive infusion therapy simultaneously through 2 - 3 venous vessels, trying to normalize the vital functions of the body. At this stage, it is possible to improve the water-electrolyte balance, restore the volume of circulating blood, increase the level of arterial and central venous pressure (CVP), reduce the pulse and increase the volume of urine (diuresis). It happens that it is not possible to restore the kidney function in 3 hours - the surgery is not postponed in this case, but the likelihood of a favorable prognosis is significantly reduced.
At the stage of preparation for surgery, catheterization of the subclavian vein is also performed, which makes it possible to monitor the CVP and increase the infusion rate. Often, the bladder is catheterized: so it is possible to measure an hourly diuresis.
As preparation of the gastrointestinal tract, gastric emptying is performed by means of a probe, which is not removed until the restoration of motility after the operation.
Stages of the operation
Treatment of purulent peritonitis, the surgeon carries out in the following sequence:
- Laparotomy - an incision is made in the middle of the abdominal cavity.
- Evacuation of exudate - a pathological fluid that fills the peritoneum, is removed with an electric pump, and the source of peritonitis is insulated with gauze napkins moistened with an antiseptic solution.
- Blockade of reflexogenic zones - novocaine is injected into the region of the celiac trunk, sigmoid and small intestine, transverse mesentery, which removes reflex vascular spasm and further promotes early recovery of peristalsis.
- Sanitation - the next stage of treatment of peritonitis of the abdominal cavity implies its washing with isotonic fluids to reduce the concentration of microorganisms in the exudate to a minimum.
- Isolation of the source of peritonitis - depending on the cause of inflammation and its stage, hemicolectomy (removal of the colon), resection of the stomach (removal of its part), removal of the appendix, gall bladder, uterine tube - that is, the organ that became the source of peritonitis.
- Decompression of the intestine during resection is carried out through the open channels of the intestine, otherwise small intestinal probes are used. The purpose of decompression is to cleanse the intestines from gases and liquid contents.
- The next stage of treatment of inflammation of the abdominal cavity implies its repeated sanitation and drainage by silicone tubes. Then it is filled with saline with antibiotics, and the incision is sewn.
Treatment of peritonitis after surgery
After 6-8 hours after suturing the wound, the exudate is drained through the drains in a passive way (due to the difference in pressure). Through the lower drainage tube, saline is again filled into the abdominal cavity with antibiotics, and left for 6 to 8 hours. Within 2 days the procedure is repeated 2-3 times.
Further treatment implies antibacterial and detoxification therapy, recovery of acid-base and water-electrolyte balance, bcc and protein content in the blood, and restoration of intestinal motility.
Immediately after the operation, the food is delivered by enteral administration of the solutions bypassing the digestive tract. Later special food is shown - the diet with the transferred peritonitis lasts at least 6 months and excludes smoked meat, pickles, marinades, chocolate, alcohol.
Useful vegetable and cereal soups , yesterday's bread, sweet fruits and berries, soft-boiled eggs, lean fish and meat dishes, honey, milk, jam.