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Full recovery from peritonitis is possible if treatment is started promptly. If untreated, peritonitis can lead to severe dehydration or a chemical imbalance (from repeated vomiting), paralysis of the intestines (ileus; see page 761), or shock (see page 579). Although peritonitis can be fatal, few people die of it because antibiotics can usually clear up the infection.

Symptoms

The main symptom of peritonitis is severe pain in the abdomen. The pain is most severe near the site of the initial disorder and increases when you move. For example, the pain from a ruptured peptic ulcer is worse in the upper midright side of the abdomen. A person usually has a fever. Other symptoms depend on the source of the inflammation or infection and can include nausea and vomiting. After a few hours the stomach becomes bloated and the pain more generalized.

Diagnosis

If you have symptoms of peritonitis, go to the nearest hospital emergency department immediately. The doctor will ask you about your symptoms and feel your abdomen to find the most painful area and identify the source of the inflammation. He or she will also order blood tests and a CT scan (see page 112). If fluid is present in the abdominal cavity, the doctor may perform a procedure called paracentesis, in which he or she inserts a needle into the cavity and withdraws a sample of fluid for evaluation. If the doctor is unsure of the diagnosis, he or she may recommend a surgical procedure called exploratory laparotomy, in which the abdominal cavity is opened to look for the cause of the disorder.

Paracentesis

In abdominal paracentesis, a doctor uses a needle and syringe to draw fluid out of the abdominal cavity for analysis in a laboratory.

Treatment

If you have peritonitis, surgery must be done immediately to correct the underlying cause. For example, a surgeon may remove a damaged segment of intestine or repair a perforated ulcer. Before surgery you will be given antibiotics intravenously (through a vein) to treat the infection, and fluids if you are dehydrated. The surgeon will place soft rubber tubes in your abdominal cavity to drain the accumulated fluid.

Intestinal Obstruction

An intestinal obstruction is a partial or complete blockage of the intestines. The most common cause of an obstruction is a band of scar tissue (adhesion) that develops as a result of abdominal surgery. The band of scar tissue can wrap around the intestine, or the intestine can wrap around the scar tissue, squeezing the intestine. An intestinal blockage can also result from inflammation from an inflammatory bowel disease (see page 764), a cancerous tumor in the colon (see page 775), a strangulated hernia (see page 762), or an indigestible mass such as hardened bulk laxative. Sometimes an intestine is obstructed because it is knotted or twisted (a condition called volvulus). In rare cases, an intestinal obstruction is caused by intussusception (see page 406), in which the intestine folds back on itself like a telescope. Intussusception occurs more frequently in infants and young children than it does in adults.

Intestinal obstructions are common. If a complete obstruction occurs, the blood supply to the intestine can be cut off, causing the tissue to die. If the blockage is not relieved, the intestine can rupture and cause peritonitis (see previous page). An untreated intestinal obstruction can eventually lead to severe dehydration or a chemical imbalance (from repeated vomiting), paralysis of the intestines (ileus; see next page), or shock (see page 579), or it can be fatal.

Symptoms

Symptoms of intestinal obstruction depend on the location of the obstruction and on whether the obstruction is complete or partial. An obstruction in the small intestine causes cramping pain in the middle of the abdomen and increasingly frequent vomiting; if vomiting temporarily relieves the cramping, the obstruction in the small intestine is probably partial. If the blockage is in the large intestine, you may not vomit or vomit very little;