Causes of peritonitis in neonates
Peritonitis in the newborn - a diseasepolietiologic, cause it can serve as a perforation of the wall of the gastrointestinal tract when malformations, necrotizing enterocolitis, and inflammatory diseases of the abdominal cavity (eg, acute appendicitis). Bacterial infection of the peritoneum while usually occurs by contact. When sepsis is also possible hematogenous or lymphogenous path of infection in the abdominal cavity, which leads to the appearance of her metastatic, usually demarcated ulcers.
In terms of the spread of peritonitis divided intospilled and delimited (abscess). For peritonitis caused by perforation of a hollow organ, characterized by a serious condition of the patient: lethargy, weakness, alternating with periodic excitation, persistent vomiting bile and greens. The skin is pale grayish-colored, dry, cold. Breathing frequent, shallow, warm tones deaf, speeded heart rate to 120-130 in 1 min, weak filling, aritmichen. Characteristically sharp bloating as diffuse tenderness to palpation. Laxation does not listen, liver dullness is not defined. Chair and gases do not depart. When the overview X-ray examination of the abdomen and chest cavity in a vertical position is determined by the free gas under the dome of the diaphragm (pneumoperitoneum).
The most common intestinal perforationwith necrotic or ulcerative enterocolitis, developing on the background of hypoxia or undergoing a protracted course of sepsis, in violation of the microcirculation in the intestinal wall as a result of prolonged spasm or thrombosis.
Often in newborns, especially premature,common acute appendicitis, which is due to late diagnosis of causes of peritonitis. The pathogenesis of acute appendicitis in premature babies has its own characteristics. It develops as a result of severe circulatory disorders by type of heart attack in the process wall. The determining factor is the excessive multiplication in the intestine pathogenic microflora (Klebsiella, Proteus, Pseudomonas aeruginosa, and so on. D.). In the case of massive antibiotic, hormone and immune-stimulating therapy possible delimitation of the inflammatory process in the abdominal cavity and the formation of appendicular infiltrate and abscess or abscesses mezhpetlevyh. The course of acute appendicitis in premature characterized by rapidly progressive toxemia, gastroparesis and intestinal (vomiting of bile, bloating, lack of chairs). Discover the classic symptoms of acute appendicitis in premature hard. Yet some patients can identify local tenderness and muscle tension, edema and hyperemia in the right iliac region. Sometimes you can palpate infiltration. It helps in the diagnosis of x-ray (defined dimming the right half of the abdomen, pneumatosis or pneumoperitoneum, obstructive delimited space in the left half of the abdomen swollen visible paretic bowel loops) and dynamic monitoring of patients.
In the absence of a hollow organ perforation spilledperitonitis is characterized by a gradual increase in symptoms of intoxication and intestinal paresis. In the analysis of blood revealed leukocytosis with a shift to the left, and radiological scoping study indicates the presence of free fluid in the abdominal cavity.
peritonitis Treatment should be operational. When perforation - closure of openings in the wall of the organ or removing the lesion ulcer on the anterior abdominal wall, careful debridement and drainage of the abdominal cavity. In acute appendicitis, appendectomy is performed ligature way. Mortality in peritonitis in newborns, especially premature, high.