PER'ITONI'TIS (Neo-Lat., from Lat. per itoneum, peritontrum, peritoneum). An inflam mation of the peritoneum (q.v.).
Peritonitis may be acute or chronic. primary or secondary. Primary or idiopathic inflammation of the peritoneum occurs after exposure to cold or wet, and is sometimes known as rheumatic peritonitis. Its rarity is rather remarkable, considering how frequently the pleura, pericar dium, and similar structures are affected. Sec ondary peritonitis is due to an extension of inflammation from or perforation of one of the abdominal viscera. By extension it may fol low an inflammation of the stomach or intes tines, or extensive ulcerations of these parts, abscess of any of the solid organs, or of the retro peritoneal tissues. Perforative peritonitis com monly arises front penetrating wounds. or ulcer of the stomach or bowels. An important cause is perforating appendicitis, which is responsible more often than any other single cause, and espe cially in young adult males. A more liberal Hood supply renders the appendix of the female less liable to damage, but, on the other hand, the generative organs are a frequent means of intro ducing an infection into the peritoneal cavity.
Acute peritonitis generally presents well-marked symptoms. It commences with a chill, or severe pain in the abdomen may be the first symptom. The pain is at first confined to particular spots (usually in the lower part of the abdomen), but it soon extends over the whole abdominal region. It is increased, on pressure, to such an extent that the patient cannot even bear the weight of the bedclothes; and to avoid, as far as possible, in ternal pressure upon the peritoneum, he lies per fectly still. on his hack, with the legs drawn up, and breathes by means of the ribs, in conse quence of the pain occasioned by the descent of the diaphragm in inspiration. The breathing is shallow, and, less air being admitted at each movement of respiration, the number of those movements is increased. There are 40 or even 60 respirations a minute, instead of IS or 20. The pulse is very frequent, often 120 or more in the minute, and small and tense, though occasionally strong and full at the commencement of the at tack. The temperature may rise rapidly after the chill to 104' or 105°, but is subsequently lower. Some very severe cases have no fever throughout the attack. Vomiting is an early and prominent symptom and causes great pain. Af ter the disease has continued for a certain time, the belly becomes tense and swollen, the enlarge ment being caused at first by flatus, and after wards also by the effusion of fluid.
The appearance of the patient when at the height of the disease is very characteristic. The 'Hippocratic countenance' is more often observed in peritonitis than in any other disease except cholera—"a sharp nose, hollow eyes, collapsed temples: the ears cold, contracted. aml their lobes turned out ; the skin about the forehead be ing rough, distended. and parched: the color of the whole face being brown, black, livid, or lead colored." Acute diffuse peritonitis is usually fatal in from two to ten days. Often death oc curs with great suddenness, due to cardiac pa ralysis.
Chronic peritonitis may result from an attack of the acute form, producing adhesions, either local or general. between the peritoneal surfaces. The intestines may be matted together or com pressed at particular points by fibrous bands. Often there are no symptoms. but if the intestine is constricted colicky pains will be felt. Tubercu losis may cause either acute or chronic perito nitis, but usually the latter. It occurs at all ages and presents symptoms of extraordinary complexity and diversity. Sometimes the condi tion is discovered by accident, during an opera tion for some other trouble. Caseous masses form, the mesenteric glands are enlarged. and the omentum is irregularly thickened. These masses can be felt through the abdominal walls. Can cerous peritonitis is usually an extension from some other organ.
The treatment of acute peritonitis must be prompt, vigorous, and persistent. In the earliest stage it may lie aborted or limited by the use of ice bags locally, and a saline or calomel purge. Complete rest is demanded at all stages of the disease. The intestinal movements may be quieted and pain allayed by the administration of opium, and in the height of the disease this is the only drug worth considering. Tolerance to opium in peritoneal inflammation is great, and comparatively large doses must be given. When due to perforation. as in appendicitis. prompt operation will often prevent the spread of the infection. Tubercular peritonitis is often cured by simply opening the abdonmen, exposing the tuberculous masses to the air, and flushing out the cavity with saline or antiseptic solutions. General treatment is unsatisfactory, but fresh air, tonics, cod-liver oil, and creosote may effect a cure.