Surgery is required in cases where peritonitis is treated conservatively for 6 to 8 hours (usually not more than 12 hours) and the symptoms of peritonitis worsen instead of decreasing.
Acute diffuse peritonitis is presented as a representative of peritonitis. Acute diffuse peritonitis is characterized by abdominal pain that is severe and persistent, nausea, vomiting, mostly gastric contents, gradual increase in body temperature, accelerated pulse rate, symptoms of toxicity (high fever, pallor, weakness, etc.), and peritoneal irritation (abdominal pressure, abdominal muscle tension, rebound pain).
Conservative treatment, i.e. non-surgical treatment, mainly includes taking appropriate position, fasting, gastrointestinal decompression, correcting water and electrolyte disorders and antibiotic treatment.
1. Body position: generally take the semi-recumbent position to promote the flow of abdominal fluid to the pelvis.
2. Fasting and gastrointestinal decompression: patients with gastrointestinal perforation need to fast and keep gastric tube to reduce the flow of gastrointestinal content to the abdominal cavity.
3. Correction of water electrolyte disorders: due to fasting, gastrointestinal decompression and a large amount of peritoneal fluid in the abdominal cavity, it is easy to cause water electrolyte disorders, which is not conducive to the recovery, so it is necessary to correct the metabolic disorders in a timely manner.
4. Antibiotics: such as three generations of cephalosporin. However, antibiotic treatment cannot replace surgery.
After the above non-surgical treatment 6~8 hours (usually not more than 12 hours) peritonitis symptoms are not relieved, then the need for surgical treatment. The vast majority of secondary peritonitis requires prompt surgical treatment.