Gangrene and perforation can occur within 6 h, so exploration must be performed expeditiously. Perforated appendix can occur at any age but is the most common cause of peritonitis in children and young adults. Tenderness in the right lower quadrant or over the entire abdomen indicates the extent of inflammation. Before operation, a high fever in children should be reduced if possible. A nasogastric tube is inserted and urine output measured.
Fluid status is maintained by adequate IV fluid and electrolyte replacement.
In late cases, a patient's condition may not improve for several hours. Perforated colon is caused by obstruction, diverticulitis, inflammatory disease, and toxic megacolon. Sometimes perforation occurs spontaneously. Perforated diverticulitis of the sigmoid or right colon is the most common cause of peritonitis from a perforated colon. Patients receiving prednisone are apt to have such perforations, which may be essentially silent anywhere in the colon.