Summary about Disease
Fecal peritonitis is a severe and potentially life-threatening infection of the peritoneum, the membrane lining the abdominal cavity and covering the abdominal organs. It occurs when fecal matter, bacteria, and other intestinal contents leak into the sterile peritoneal space. This leakage causes intense inflammation and can lead to systemic sepsis, multiple organ failure, and death if left untreated. It is a surgical emergency.
Symptoms
Symptoms of fecal peritonitis can develop rapidly and include:
Severe abdominal pain and tenderness, often worsening with movement
Abdominal distension and rigidity ("board-like" abdomen)
Fever and chills
Nausea and vomiting
Rapid heart rate (tachycardia)
Rapid breathing (tachypnea)
Decreased or absent bowel sounds
Dehydration
Confusion or altered mental status
Hypotension (low blood pressure)
Oliguria (decreased urine output)
Causes
Fecal peritonitis is typically caused by a breach in the gastrointestinal tract, allowing fecal contents to enter the peritoneal cavity. Common causes include:
Perforated Viscus:
Perforated peptic ulcer
Perforated appendicitis
Perforated diverticulitis
Perforated colon cancer
Bowel obstruction with perforation
Trauma:
Penetrating abdominal injuries (e.g., gunshot or stab wounds)
Blunt abdominal trauma leading to bowel rupture
Surgical Complications:
Anastomotic leak (leakage from a surgical connection between two parts of the intestine)
Inadvertent bowel injury during surgery
Inflammatory Bowel Disease (IBD):
Severe Crohn's disease or ulcerative colitis leading to bowel perforation
Ischemic Bowel:
Intestinal ischemia (lack of blood flow) resulting in bowel necrosis and perforation
Medicine Used
The primary treatment for fecal peritonitis is surgical intervention to address the source of the contamination and clean the peritoneal cavity. Medications are used as supportive care and to combat infection:
Broad-spectrum antibiotics: These are crucial to fight the bacterial infection. Common choices include combinations such as:
Carbapenems (e.g., meropenem, imipenem-cilastatin)
Piperacillin-tazobactam
Ceftriaxone or cefepime plus metronidazole
Intravenous fluids: To correct dehydration and maintain blood pressure.
Vasopressors: (e.g., norepinephrine) to increase blood pressure if fluids are insufficient.
Pain management: Opioids or other analgesics to control severe abdominal pain.
Nutritional support: Parenteral nutrition (IV feeding) may be necessary if the patient cannot tolerate oral intake.
Is Communicable
Fecal peritonitis is not communicable. It is not an infectious disease that spreads from person to person. It is a consequence of a disruption within the patient's own body, leading to contamination of the peritoneal cavity.
Precautions
Precautions focus on preventing conditions that lead to bowel perforation or injury:
Prompt treatment of abdominal infections: Seek medical attention for conditions like appendicitis or diverticulitis to prevent perforation.
Safe surgical practices: Surgeons must meticulously perform bowel surgeries to minimize the risk of anastomotic leaks or bowel injuries.
Protective measures during trauma: Wear seatbelts and take precautions to prevent abdominal injuries.
Careful management of IBD: Aggressive medical management of Crohn's disease and ulcerative colitis to prevent severe inflammation and perforation.
Awareness of NSAID risks: Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the risk of peptic ulcers and perforation.
Early recognition of symptoms: Promptly seek medical evaluation for persistent abdominal pain or changes in bowel habits.
How long does an outbreak last?
Fecal peritonitis is not an "outbreak" situation like a contagious disease. It's an acute, individual medical emergency. The "duration" refers to the time from the onset of symptoms until definitive treatment (usually surgery) is initiated. The longer the delay in treatment, the worse the prognosis. Without prompt intervention, fecal peritonitis can rapidly progress to sepsis and death within hours to days.
How is it diagnosed?
Diagnosis involves a combination of clinical assessment, laboratory tests, and imaging studies:
Physical Examination: Assessing for abdominal tenderness, rigidity, distension, and vital signs.
Blood Tests:
Complete blood count (CBC): Elevated white blood cell count (leukocytosis) indicates infection.
Electrolytes and renal function: To assess for dehydration and kidney function.
Lactate levels: Elevated lactate may indicate tissue hypoperfusion and sepsis.
Blood cultures: To identify bacteria in the bloodstream (sepsis).
Imaging Studies:
Abdominal X-ray: May show free air in the abdomen (pneumoperitoneum), suggesting bowel perforation.
CT scan of the abdomen and pelvis: This is the most sensitive imaging modality. It can identify the source of the perforation, locate abscesses, and assess the extent of the peritoneal contamination.
Peritoneal Fluid Analysis (if applicable): In rare cases, if a diagnostic peritoneal tap (paracentesis) is performed, analysis of the fluid will show high white blood cell count, bacteria, and fecal material.
Timeline of Symptoms
The timeline can vary depending on the underlying cause and the individual's overall health. However, a general progression is as follows:
Initial Stage (Hours): Sudden onset of severe abdominal pain, often localized initially but quickly becoming generalized. Tenderness to the touch.
Early Stage (Hours - 1 Day): Abdominal distension, nausea, vomiting, fever, rapid heart rate. Pain intensifies.
Late Stage (1-3 Days): Abdominal rigidity ("board-like abdomen"), decreased or absent bowel sounds, dehydration, altered mental status, low blood pressure, decreased urine output. Sepsis develops.
Critical Stage (Days): Multiple organ failure, shock, coma, and death if untreated.
Important Considerations
Surgical Emergency: Fecal peritonitis is a surgical emergency requiring immediate intervention.
Early Diagnosis is Crucial: Prompt diagnosis and treatment significantly improve the chances of survival.
Sepsis Risk: Fecal peritonitis carries a high risk of developing sepsis, a life-threatening condition caused by the body's overwhelming response to infection.
Mortality Rate: Despite advances in medical and surgical care, the mortality rate associated with fecal peritonitis remains significant, especially in elderly or immunocompromised patients.
Source Control: The primary goal of treatment is to identify and control the source of the contamination (e.g., repair the bowel perforation).
Peritoneal Lavage: Thorough irrigation of the peritoneal cavity is essential to remove fecal material and bacteria.
Post-operative Care: Intensive post-operative care is required, including monitoring for complications such as abscess formation, wound infection, and respiratory failure.
Multidisciplinary Approach: Management of fecal peritonitis requires a multidisciplinary approach involving surgeons, intensivists, infectious disease specialists, and other healthcare professionals.