Clinical features of localised peritonitis

The clinical features of localised peritonitis are:

• a primary intra-abdominal process, e.g. appendicitis
• localised abdominal pain - made worse by movement of the abdomen e.g. coughing.
• on examination there are signs of localised peritonism:
  • localised tenderness
  • contraction of the abdominal muscles over the area of tenderness when palpation is attempted - guarding
  • rebound tenderness - when the examining hand is quickly examined the movement of the peritoneum causes intense pain. This sign may be better elicited by percussion or asking the patient to cough.
• rectal tenderness - anterior tenderness may be elicited
• features of mild systemic toxicity, e.g. malaise, low-grade fever, tachycardia, leucocytosis on FBC.