Peritonitis

Abstract

Peritonitis is defined as an inflammatory process of the peritoneum caused by any irritant/agent such as bacteria, fungi, virus, talc, drugs, granulomas, and foreign bodies. The clinical spectrum of peritonitis may be classified according to the pathogenesis as primary, secondary, or tertiary peritonitis. The diagnosis of peritonitis is a clinical diagnosis, based mostly on history and physical examination. Several variables create complexities in securing a diagnosis in elderly patients. These include the physiologic changes that accompany aging, difficulties with taking an adequate history, medications that cause or confound pathology, lack of expected vital sign changes and physical findings, significant comorbidities, and seemingly normal laboratory values in the face of surgical disease. Acute abdomen in elderly patients poses a difficult challenge for emergency physicians. Radiological imaging is an important part of patient workup, separating mundane causes from those requiring active medical intervention. In elderly patients with acute abdominal pain, the general usefulness of plain radiographs is limited mainly to evaluation for free intraperitoneal air, signs of obstruction, or foreign body ingestion or insertion. Conventional radiography in the evaluation of acute abdomen in elderly patients has been replaced by ultrasound, MDCT, and sometimes MR. Ultrasound is the primary imaging modality of choice for the evaluation of right upper quadrant pain. Over the years, MDCT has gained a key role in the acute abdomen diagnostic process and especially in acute diseases of the small and large intestine. It has thus reduced the use of conventional radiology due to its clear benefits of fast execution, broad view, and objective interpretation, as well as its ability to enable differential diagnosis in the event that the initial clinical suspicion is not confirmed, especially in the elderly patients.