Peritonitus

[yealand]

I recently spent 2 weeks in hospital with peritonitus which was treated conservatively with iv antiobiotic drips and pethadine injections for pain relief.
I had ultrasound scan and abdominal xrays.
I was told it was a possible perforated duodenal ulcer, but now the doctors don't think it was that and are unsure of the cause of the peritonitus.  I had no symptoms of an ulcer before this.
My stomach was very distended and very sore.
Any gynocoligy problems were ruled out through pelvic examination and the scan. Although a small cyst was found on my left ovary which is not problem.
And the scan showed up possible bowel distention on my right side.
I am very concerned about what caused the peritonitus and if it will happen again, do you have any idea what could have caused it?
My stomach is still swollen after 2 months and I have been very tired since, is this normal, I also have a heavy uncomfortable feeling in my lower abdomen would this be something to do with a distended bowel and is this likely to clear up on its own? and could the peritonitus be something to do with this?  The doctors are reluctant to take a look inside as they say surgery could be dangerouse at this time.  Look forward to some answers.

[Kevin Pho, MD]

Any type of infection extending to the abdomen can lead to peritonitis.  Bowel perforation is one cause.  Non GI-tract infections, such as cellultis, UTIs, pharyngitis, or dental infections can lead to GI tract seeding of bacteria.  

If there is a concern about perforation, then further studies should be considered - including imaging studies like an abdominal CT scan.  If performation is not a consideration, then an upper endoscopy can be considered to evaluate for an ulcer.

You may want to discuss these options with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[yealand]

Thanks for the reply to my question, but I'm still concerned about having a distended bowel and the tiredness I've been feeling since I was ill, is this a normal reaction to peritonitus and if the root cause is not known, is it likely to happen again?

[surgeon]

bowel distention can persist for some time after peritonities, depending on severity. However, most people would not still be having it at two months. That, combined with persisting tiredness, raises the possibility of persisting problems that might or might not resolve on their own. I'd agree operation would be unlikely to help if a specific "target" is not identified. But I'd be thinking about further investigation, such as CT scan with contrast, whether or not perforation was on the list of possibilities. Depending on what is found to explain the distention (it could be the bowel, or fluid, among other things) then it would be easier to decide what further testing or investigating would likely be useful, such as upper or lower endoscopy, draining of fluid, surgery.

[yealand]

Thanks for your comments, I go for another ulrasound scan in 2 weeks to check how things are going, but I think I may ask for a CT scan which will probably show up more than a scan?
I also have a yellow slimy discharge from the front passage which has only started since I had peritonitus.
But gyni exam has ruled out any problems there apparently.
I also have started with a nasty ear infection which hasn't cleared up with antibiotic drops so I'm now on amoxyllin.
I must be run down, as I've also had a cold and chesty cough.