To the Editor.—The article "Generalized Peritonitis" by Hunt (Archives 1982;117:209-211) correctly stressed the high mortality and the morbidity in generalized peritonitis from perforation of the colon. It also stressed the importance of prompt discovery and operation, and the greater risk in the aged.
However, Dr Hunt did not mention fluid replacement in these patients. Was fluid intake and output monitored, and was fluid replacement maintained satisfactorily in all patients? This problem has been addressed by other authors.1,2
I have recently been involved in a malpractice suit for a case of barium-related peritonitis in which fluid replacement was not monitored, resulting in hypotension, renal shutdown, and ultimate death of the patient. The principle of adequate fluid administration must be stressed. One recurring cause of generalized peritonitis is perforation from a barium enema. As in Dr Hunt's cases, immediate treatment, including fluid therapy, is mandatory to increase the rate of
MILLER RE. Fluid Replacement in Peritonitis. Arch Surg. 1982;117(10):1371. doi:10.1001/archsurg.1982.01380340085020