Diagnosis Secondary Peritonitis

Fever, diffuse abdominal pain, nausea, and vomiting are characteristic symptoms. Signs of peritoneal inflammation, including rebound tenderness, abdominal wall rigidity, and decrease in bowel sounds are observed. These may be later followed by shock, toxemia, restlessness and irritability, a higher temperature, an increase in the pulse rate, chills and convulsions.

An elevated blood leukocyte count in excess of 12,000 with a predominance of polymorphonuclear forms is often present. Abdominal roentgenograms may reveal free air in the peritoneal cavity, evidence of ileus or obstruction and obliteration of the shadow of the psoas muscle. Computed tomography (CT) scanning and ultrasonography can improve the diagnostic accuracy of appendicitis.

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