What is peritonitis?

A thin layer of tissue called the peritoneum lines our abdomen and the organs inside it such as the stomach, intestines, pancreas, and liver. Sometimes, due to factors such as an infection, trauma, or other medical causes, the peritoneum can get swollen or inflamed leading to a condition called peritonitis. This causes severe complications and needs to be treated immediately. Depending on the cause, surgical treatment may be needed for peritonitis. Understanding the rationale behind the treatment, the precautions to be taken and the lifestyle changes it entails, can improve the outcome of treatment and reduce the chances of developing this disease again. Let us understand what happens when you get diagnosed with peritonitis, your stay in the hospital and the recovery period at home.

Surgery for peritonitis

The first thing that is considered while creating the treatment plan is the ‘why?’ Peritonitis can be caused by a stomach infection, a hole in your stomach or intestines, severe appendicitis, a burst appendix, or pus-filled swellings in the peritoneum. You will first be given antibiotics and fluids through an intravenous (IV) line. A feeding tube is placed to reduce the digestive burden on your intestines. In some circumstances when the feeding tube cannot be placed, nutrients are given through the IV line. ¹

Surgical interventions

Burst appendix

The surgeons will use keyhole surgery to remove the appendix and any damaged tissues in your abdomen.²

Infections

There may be pus-filled in the abdomen. These can rarely develop due to previous surgical procedures in the abdomen or complications of some infectious diseases. These abscesses are drained surgically and any damaged parts of peritoneal tissue and organs are removed and the healthy tissue repaired.³

Defect or leak in the stomach and intestines

Sometimes untreated stomach and intestinal ulcers can cause a hole in the organ causing acids, enzymes and undigested food to leak out into the abdomen and inflame the peritoneum. This causes peritonitis and needs to be surgically operated.⁴

Trauma

In emergency cases, the surgical team will have to open your abdomen and look for signs of trauma, foreign objects or damage and repair them.⁵

Postoperative care in hospital

In the hospital, supportive treatments are administered throughout your stay to manage your pain, hydration levels and nutrition while ensuring that you are able to return to your daily routine as soon as possible. Some key aspects of treatment while you are admitted include the following:

• Monitoring vital signs: Your temperature, blood pressure, respiratory rate, heart rate and general state are carefully monitored by the medical team. This is done to look out for warning signs of complications such as bleeding or infection. If you have any other underlying illnesses like diabetes, hypertension or any other illnesses, these are carefully monitored and noted in your charts to ensure that you receive the most appropriate treatment⁶
• Pain management: Postoperative pain is an expected symptom and resolves as the healing continues. Adequate pain relief is given, first through your IV line and consequently through tablets as you start drinking and eating normally⁷
• IV fluids: Maintaining fluid and electrolyte levels is important to ensure normal organ functioning in the body. A catheter is placed during the surgery and is removed once your condition is stable⁸
• Nutrition: A feeding tube is usually placed in the stomach, however sometimes; nutrients are administered through the IV line as Total Parenteral Nutrition. This is done until oral foods and liquids are resumed
• Wound care: The site of surgery through which the surgical team opened up your abdomen must be attended to carefully in the days leading to recovery⁹
• Infection prevention: Healthcare providers follow strict infection control measures including hand hygiene, sterile technique and personal protective equipment while doing procedures and changing wound dressings¹⁰
• Early mobilisation: You will be encouraged to move as soon as your body can tolerate it. This prevents some complications such as blood clots, pneumonia and muscle weakness. The medical team will assist you in gradually increasing your activity levels, from sitting up, to going on short walks and physiotherapy. This ensures that you are fit for your daily activities and routine¹¹

Recovery at home

Once you are stable and cleared by the surgical team, you will be discharged from the hospital with instructions for a speedy recovery at home. It is essential to implement the advice given by the medical team to prevent complications.

Pain management

Over-the-counter pain medications will be given to you for mild to moderate pain. If your pain is severe, stronger pain medications will be added to the medications you have to take home.

Medications

Some medications you can expect to be given are:

• Antibiotics
• Medication to prevent blood clots
• Laxatives, if you are given stronger painkillers
• Anti-nausea medications
• Other medications specific to your symptoms

It is vital to keep your discharge sheet and prescription accessible so that you take your medications on time and at the correct dosage. It can be beneficial for your family or partner to be present while the team explains the discharge instructions to you so that they can take better care of you.

Dietary instructions

• Post-surgery for peritonitis, you may be recommended to have a bland diet that is easily digestible to avoid irritating the stomach and intestines further. Foods such as soups, broths, plain rice, boiled vegetables and lean proteins are recommended. Avoid heavily processed, spicy and oily food, as they can cause significant discomfort¹²
• You must drink plenty of fluids, fresh fruit juices or mild tea to ensure proper hydration and support healing¹²

Gradual return to normal activities

Maintaining activity levels is essential for a speedy recovery. Going on short walks, gentle stretching, and gradually progressing to more strenuous activities. Too much rest or idleness can create complications such as blood clots and muscle weakness. Once you are able to tolerate the gradual progression of physical activity you can return back to your work and daily routine as before.¹³

Signs of complications and emergencies

Some warning symptoms that warrant a visit to the emergency department or your GP are as follows.

• Persistent fever or chills
• Worsening abdominal pain or tenderness
• Redness, pain and swelling with discharge from the surgical wound site
• Persistent nausea, vomiting or diarrhoea
• Difficulty breathing
• Chest pain¹⁴

Follow-up

Long-term follow-up is important for individuals who have undergone treatment for peritonitis to monitor their recovery, keep track of any complications and prevent the condition from occurring again.¹⁵

Follow up appointments

Your follow-up appointments will be set up when you are discharged. During these appointments, the healthcare providers will ask you questions about your recovery, examine you, assess your progress, monitor signs of complications and do lab tests. You can discuss any concerns you are having with the treatment, the effects of the medications and your lifestyle.¹⁵

Monitoring for recurrence or complications

There are chances of the condition recurring, especially if the underlying cause has not been addressed completely, but it is rare. Therefore, regular monitoring is essential. Additionally, early detection of complications such as surgical site infections, abscesses, or improper wound healing can reduce further issues.¹⁵

Lifestyle modification

Adopting a healthy lifestyle is essential, not only to recover but also to improve overall health.

• Maintaining good hygiene practices, regular good hand hygiene, and proper wound care as per the surgical teams’ instructions
• Healthy diet practices, rich in fruits and vegetables, whole grains and lean proteins to maintain immune function
• Avoiding smoking and drinking, heavily processed, fatty and high-sugar foods
• Managing underlying conditions like diabetes, gastritis or other illnesses well¹⁵

Summary

• Peritonitis is the inflammation of the layer surrounding the abdominal organs. It causes symptoms such as severe abdominal pain and tenderness, nausea, fever and general discomfort
• Peritonitis can be caused by infections, ruptured appendix, ruptured ulcers in the stomach or intestine, infections and abscesses
• Surgical management depends on the cause. Keyhole surgeries or open surgeries can be done based on severity
• In the hospital, management includes antibiotics, fluids, a feeding tube or total parenteral nutrition
• Early mobilisation, regular monitoring and a healthy diet are encouraged to ensure a speedy recovery