Chronic Peritonitis.

Definition.—Chronic inflammation of the peritoneum.

Etiology.—This form usually follows one or more attacks of acute peritonitis, the causes of which have been named under the acute form. Less frequently it may occur without a previous-attack, especially where there is a malignant, tubercular, or rheumatic diathesis.

Pathology.—Adhesive Peritonitis.—This usually follows the acute attack, the peritoneal layers frequently becoming inseparably glued together and very much thickened, while coils of intestine become attached to each other and to neighboring parts.

Proliferative Peritonitis.—In this variety there are few or no adhesions, but marked thickening of the peritoneum. This is apt to be associated with cirrhosis of the liver, stomach, or kidneys, and not infrequently is due to chronic alcoholism. Thickening of the omentum may sometimes give rise to a thick, hard cord or band running transversely across the upper part of the abdomen.

There may be effusion varying in character and quantity, and occupying the abdominal cavity at large, or confined to pockets due to adhesion.

Hemorrhagic Peritonitis.—Virchow first described this form of peritonitis, in which a new membrane of connective tissue covers the peritoneum, and in which extravasation of blood occurs from the newly developed open blood-vessels. It may follow frequent wounding of the peritoneum by paracentesis.

Chronic Tuberculous Peritonitis.—The thickening of the layers of the peritoneum, to all appearance, are similar to those forms already described; but on examination with the microscope, tubercular degeneration is found.

Localized peritonitis results in firm, fibrous adhesions, and is usually preceded by inflammation of some spinal part.

Symptoms.—Chronic peritonitis always develops insidiously, the symptoms in the earlier stages being more or less obscure, and of little clinical significance. Disorders of digestion are always present to some extent, and where adhesions restrict the common duct or portal vein, jaundice or ascites, or both, will be present.

Constipation is a common condition, save in tubercular peritonitis, when diarrhea prevails. There is nearly always pain or uneasiness in some portion of the abdomen.

The fever is of an irregular type, the tongue is furred, the face assumes an anxious or pinched look, emaciation follows, and there is nervous disturbances.

The abdomen is generally prominent, either distended with .gas or effusion; frequently both are present.

Percussion reveals dullness, where ascitic iluid is present, or where adhesions are firm and thick; and resonance, where gas is present. Not infrequently a hard band can be outlined across the upper part of the abdomen, a roll of omentum being responsible for this condition.

Diagnosis.—A history of the case shows a former attack of acute peritonitis, or a gradual impairment of health, with disturbance of digestion and more or less abdominal pain. A physical examination generally reveals the true condition.

Prognosis.—When the disease is of long standing, with adhesions and thick fibrous bands, together with profuse effusion, the prognosis is unfavorable; but if seen in the early stages, and the environments of the patient are good, a favorable result may be anticipated.

Treatment.—In the treatment of chronic peritonitis, bryonia, colocynth, and dioscorea should be given a thorough trial. Bryonia stimulates the absorption of the inflammatory products, and also acts as a pain-reliever. The sharp colicky pain is benefited by colocynth, and soreness calls for dioscorea.

Iodide of arsenic, first trituration, will also be found useful. The chlorates and mineral acids will have their special indications. Where there is ascites, the distillate of apocynum will prove useful. Locally, much benefit will follow the use of the thapsia plaster.

The diet should be selected so as to avoid gas formation; sweets and excessively starchy foods should be discarded, and also coarse vegetables. The sanitary conditions should be the best, and, when possible, a change of climate often proves highly beneficial. Some cases will require the surgeon.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.