Peritoneal Exudate

Abstract

The existing methods for diagnosis of various conditions affecting the peritoneum have not been uniformly satisfactory. The deficiency in the exact procedures has been felt especially in certain situations such as the recognition and differentiation of primary and secondary peritonitis in children, the determination of the bacterial species in the primary type and the separation of irritative from infectious conditions of the peritoneum. Even less adequate are the available means of establishing prognosis of a phase of peritonitis. The degree of bacterial activity within the peritoneal cavity, especially in the earlier stages of an infection, does not produce clinical manifestations comparable to the potential damage of which the bacteria are capable. The sudden transformation of a patient's condition from a relatively benign to a critical state is by no means as unexpected as the outward manifestations would indicate. The major activities of the bacteria occur within the confines of the peritoneal cavity somewhat isolated because of a functional impairment of the serous membrane. Multiplication of bacteria and pro¬ duction of toxic substances proceed within the cavity until sufficient quantities of the toxic products become available for absorption. As a result, a profound intoxi¬ cation makes its sudden appearance without obvious preliminary clinical warnings. Since peritonitis is a rapidly progressing disease, with each of its stages requiring individual therapeutic management,1 treat¬ ment is handicapped also by the absence of satisfactory criteria that would indicate the degree of infection.During a series of experimental investigations con¬ cerning the interrelationship between infection and resistance in peritonitis, it was noted that several ele¬ ments in the peritoneal fluid varied with the conditions of the experiment. On the basis of this observation and with the background of available data regarding bacteriology and cytology of peritonitis and the diag¬ nostic abdominal puncture in children, the peritoneal fluid of a number of patients with varying intraabdominal conditions was examined and correlated according to the stage of the disease and the eventual outcome. BACKGROUND OF THE PROBLEM