Acute perforation and rupture of intra-abdominal organs are the most common causes. Perforation of hollow organs often occurs suddenly due to ulceration or necrotic lesions. Examples include peptic ulcers, acute cholecystitis, typhoid ulcers, perforated stomach or colon cancer, ulcerative colitis, tuberculous enteritis, amebic colitis, diverticulitis, etc.
Spread of acute infections in intra-abdominal organs: Infections like acute appendicitis, cholecystitis, pancreatitis, diverticulitis, ascending infections in the female reproductive tract (such as puerperal salpingitis), can extend to the peritoneum, causing acute diffuse peritonitis.
Acute intestinal obstruction: Strangulating intestinal obstructions like intussusception, volvulus, incarcerated hernia, mesenteric vascular occlusion, or thrombosis can lead to ischemic bowel injury. Damaged intestinal walls lose their normal barrier function, allowing bacteria to invade the abdominal cavity, leading to acute diffuse peritonitis.
Abdominal surgical situations: Penetration of abdominal organs by sharp instruments or bullets can result in perforation of hollow organs or introduction of external bacteria into the abdominal cavity. Blunt abdominal trauma may also cause visceral rupture, leading to acute diffuse peritonitis. During abdominal surgery, inadequate sterilization can introduce bacteria into the abdominal cavity. Additionally, surgical complications such as leakage from the sutures of the stomach, intestines, gallbladder, or pancreas can contribute to peritonitis. Improper aseptic procedures during abdominal puncture or peritoneal dialysis can also lead to acute diffuse peritonitis.
Complications of Acute Diffuse Peritonitis:
Due to widespread abdominal infection, the most common complications are sepsis and bacteremia.
In the later stages, patients may experience peripheral circulatory failure, renal or pulmonary failure, leading to death.
Typical Symptoms of Acute Diffuse Peritonitis:
The onset of peritonitis can be sudden or gradual, depending on the underlying cause. For example, peritonitis caused by acute perforation or rupture, such as perforated peptic ulcer or traumatic injury to abdominal organs, tends to occur suddenly. On the other hand, peritonitis caused by conditions like acute appendicitis may have preceding symptoms related to the primary disease before the manifestation of peritonitis.
Primary clinical manifestations of acute peritonitis include early signs of peritoneal irritation (abdominal pain, tenderness, abdominal muscle rigidity, and rebound tenderness). In the later stages, systemic manifestations of infection and toxicity become prominent.
Main Symptoms:
Abdominal Pain: Intense, continuous pain aggravated by deep breathing, coughing, or body movement.
Nausea, Vomiting: Common early symptoms, with vomiting initially containing stomach contents and later possibly bile or fecal matter in cases of paralytic ileus.
Fever: Gradual rise in body temperature, with an increased pulse rate associated with fever. In elderly or debilitated patients, fever may not always correlate with the severity of the condition.
Prevention of Acute Diffuse Peritonitis:
Timely treatment of common conditions like appendicitis and peptic ulcers is crucial.
Patients who have undergone abdominal surgery should maintain wound cleanliness to prevent contamination of the abdominal cavity.
Avoiding upper respiratory tract infections, enhancing overall health, and improving the body’s disease resistance are preventive measures.
Laboratory Tests for Acute Diffuse Peritonitis:
Diagnostic abdominal puncture plays a crucial role. If purulent fluid is aspirated, and a high number of white blood cells or pus cells are observed under high magnification, a definitive diagnosis can be made. If necessary, sterile punctures at different locations in the abdomen can provide additional information about the abdominal situation.
Dietary Recommendations for Patients with Acute Diffuse Peritonitis:
A low-salt, low-fat diet is recommended. Avoidance of irritating foods is advised. High-protein and high-vitamin diets are beneficial.
Example diets include ginger porridge (15g of crushed ginger in hot porridge, seasoned with salt) and rhubarb honey water (15g of rhubarb soaked in 200ml boiling water for 15 minutes, mixed with honey, and consumed as tea).
Conventional Western Medical Treatment for Acute Diffuse Peritonitis:
Treatment in Western medicine may involve the following approaches based on TCM (Traditional Chinese Medicine) differentiation:
Blood Stasis Type: Treat with blood-activating and stasis-resolving methods. Representative formula: Xuefu Zhuyu Tang with modifications.
Gastrointestinal Heat Type: Treat with purgation and detoxification methods. Representative formula: Da Chengqi Tang combined with Huanglian Jiedu Tang.
Collapse Type: Treat with clearing fever, detoxification, and nourishing yin methods. Representative formula: Qingwen Baihu Tang combined with Qingying Tang with modifications.
