Peritonitis in newborns

Peritonitis in newborns is a polyethological disease, which can be caused by perforation of the wall of the gastrointestinal tract due to its malformations, necrotic enterocolitis, and inflammatory diseases of the abdominal cavity (for example, acute appendicitis). Bacterial infection of the peritoneum, as a rule, occurs by contact. In sepsis, hematogenous or lymphogenic pathway of infection into the abdominal cavity is also possible, which leads to the appearance of metastatic, usually delimited abscesses in it.

By the degree of distribution, peritonitis is divided into a diffuse and delimited (abscess). For peritonitis caused by the perforation of the hollow organ, the patient's severe condition is characteristic: lethargy, adynamia, followed by periodic excitation, persistent vomiting with bile and greens. The skin is greyish-pale color, dry, cold. Breathing is frequent, superficial, cardiac tones are deaf, pulse is increased to 120-130 in 1 min, weak filling, arrhythmic. Characterized by a sharp swelling of the abdomen, diffuse soreness in palpation. Peristalsis of the intestine is not heeded, liver dullness is not determined. The chair and the gases do not depart. With an overview radiographic examination of the abdominal and thoracic cavities in the vertical position, a free gas under the dome of the diaphragm (pneumoperitoneum) is determined.

The most frequent intestinal perforation is with necrotic or ulcerative enterocolitis developing against a background of hypoxia or a protracted course of sepsis, with microcirculation in the intestinal wall resulting from prolonged spasm or thrombosis of the vessels.

Often in newborns, especially premature babies, there is acute appendicitis, which, because of untimely diagnosis, causes peritonitis. The pathogenesis of acute appendicitis in premature infants has its own characteristics. It develops as a result of severe circulatory disorders by the type of infarction in the wall of the appendage. The determining factor is the excessive multiplication in the intestine of a conditionally pathogenic microflora (Klebsiella, Proteus, Pseudomonas aeruginosa, etc.). In the case of the use of massive antibacterial, hormonal and immunostimulating therapy, it is possible to distinguish the inflammatory process in the abdominal cavity and the formation of appendicular infiltrates and abscess or inter-loop abscesses. The course of acute appendicitis in premature is characterized by rapidly increasing toxicosis, paresis of the stomach and intestines (vomiting with bile, bloating, lack of stool). It is difficult to detect classical symptoms of acute appendicitis in premature infants. Nevertheless, in some patients it is possible to identify local soreness with palpation and muscle tension, edema and hyperemia in the ileal region to the right. Sometimes it is possible to palpate infiltration. Helps in the diagnosis of radiologic examination (determined by darkening the right half of the abdomen, pneumatosis or pneumoperitoneum, delimited by the subhepatic space, in the left half of the abdomen are seen paretic swollen intestinal loops) and dynamic observation of the patient.

In the absence of perforation of the hollow organ, diffuse peritonitis is characterized by a gradual increase in the symptoms of intoxication and intestinal paresis. In the blood test, leukocytosis is found with a shift of the formula to the left, and a review X-ray study indicates the presence of a free fluid in the abdominal cavity.

Treatment of peritonitis should be prompt. At perforation-suture the hole in the organ wall or remove the affected area of ​​the intestine on the anterior abdominal wall, carefully sanitize and drain the abdominal cavity. In acute appendicitis, appendectomy is performed by a ligature method. Mortality in peritonitis in newborns, especially premature babies, is high.