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Peritonitis

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Abstract

Peritonitis is inflammation of the abdominal cavity that can occur spontaneously or as a result of pre-existing intra-abdominal pathology or penetration of the body wall. Peritonitis can be classified as primary or secondary, localized or generalized, and aseptic or septic. This chapter looks at the aetiology, pathophysiology, diagnosis and pre- and postoperative treatment of peritonitis. Open abdominal drainage; Closed suction drainage; Vacuum-assisted peritoneal drainage.

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Figures

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18.1 Sclerosing peritonitis resulting from a biliary effusion. It is difficult to identify any normal abdominal organs, owing to the thick fibrous covering.
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18.3 Closed-needle abdominocentesis prevents free air from entering the abdomen (which might make it difficult to interpret abdominal radiographs later).
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18.4 Diagnostic peritoneal lavage. (a) Multi-fenestrated catheter with trocar. (b) The catheter is placed aseptically into the abdomen after tranquillization and local anaesthesia. Fluid is infused via the catheter. (c) The catheter is connected to a collecting system after the patient has been rolled from side to side. This type of catheter can also be used to drain the abdomen of patients with uroperitoneum.
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18.5 Diagnostic plan for fluid obtained by abdominocentesis. Peritonitis is present if lavage fluid contains >2 × 10 nucleated cells/l in patients without prior abdominal surgery or >9 × 10 nucleated cells/l in postsurgical patients. Diagnostic peritoneal lavage will dilute the sample, which may affect the results of fluid and chemical analysis. GI = gastrointestinal; PCV = packed cell volume, WBC = white blood cell.
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18.6 Fluid cytology of samples obtained by abdominocentesis showing white blood cells with (a) intracellular bacteria and (b) bile pigment. Both findings indicate disease processes that require surgical intervention.
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18.7 Lateral abdominal radiograph showing pneumoperitoneum. Note the free air. If this patient has not had recent surgery, penetrating trauma or open-needle abdominocentesis, exploratory surgery is indicated.
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18.8 Lateral radiograph of a dog with a colonic torsion and peritonitis. All bowel loops are severely dilated and the extremely distended colon is seen ventrally. Poor serosal detail is related to abdominal effusion. This radiograph indicates the need for immediate surgical exploration.
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18.9 Abdominal ultrasonogram of the gallbladder (GB). The striated bile pattern and fluid outside the gallbladder wall are indicative of a ruptured gallbladder mucocele.
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18.12 Gastrojejunostomy tube. (a) The gastric tube is placed through a purse-string suture in the body of the stomach. (b) The jejunostomy tube is measured so that 10–15 cm of the tube will be in the jejunum. (c) The external end of the stomach tube is cut off and the jejunostomy tube is placed through the stomach tube and ‘milked’ into the jejunum. (d) When the jejunostomy tube is in the jejunum, the stomach is sutured to the body wall around the gastric tube exit site. The port to the stomach tube can be used to evacuate air and fluid from the stomach while the patient is fed via the port to the jejunostomy tube. (e) When the patient can tolerate stomach feeding, the jejunal tube can be removed.
Image of Open abdominal drainage incision.
Open abdominal drainage incision. Open abdominal drainage incision.
Image of Preassembled sterile bandage that is placed over the open incision and secured to the patient with water-impermeable adhesive tape.
Preassembled sterile bandage that is placed over the open incision and secured to the patient with water-impermeable adhesive tape. Preassembled sterile bandage that is placed over the open incision and secured to the patient with water-impermeable adhesive tape.
Image of Closed suction drain (Jackson–Pratt drain with reservoir bulb).
Closed suction drain (Jackson–Pratt drain with reservoir bulb). Closed suction drain (Jackson–Pratt drain with reservoir bulb).
Image of Placement of drains. The cranial drain is placed between the liver and diaphragm. The caudal drain is placed ventrally in the caudal abdomen.
Placement of drains. The cranial drain is placed between the liver and diaphragm. The caudal drain is placed ventrally in the caudal abdomen. Placement of drains. The cranial drain is placed between the liver and diaphragm. The caudal drain is placed ventrally in the caudal abdomen.
Image of Postoperative bandage with drain.
Postoperative bandage with drain. Postoperative bandage with drain.
Image of Vacuum-assisted peritoneal drainage. A catheter has been inserted into the foam and placed over the open portion of the abdominal incision. An adherent drape maintains an airtight seal. Sterile tubing connects the catheter to the suction unit.
Vacuum-assisted peritoneal drainage. A catheter has been inserted into the foam and placed over the open portion of the abdominal incision. An adherent drape maintains an airtight seal. Sterile tubing connects the catheter to the suction unit. Vacuum-assisted peritoneal drainage. A catheter has been inserted into the foam and placed over the open portion of the abdominal incision. An adherent drape maintains an airtight seal. Sterile tubing connects the catheter to the suction unit.

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