These old-standing lesions cause atrophy of the abdominal organs, contraction of the intestine, and sometimes true obstruction.
In chronic tuberculous peritonitis the adhesions between the intestine and the abdominal walls may be enormous. The peritoneum is generally covered with great masses of tuberculous new growth, while the mesenteric and sublumbar lymphatic glands are attacked.
Symptoms. The disease develops without marked fever or grave interference with the chief functions, and the first approach of the disease may, therefore, easily be overlooked. Chronic peritonitis, moreover, may remain strictly localised.
When the disease assumes the ascitic form the dominant sign is readily detected. Where new membranes form the principal lesions the symptoms are much less definite, and the existence of disease is chiefly indicated by digestive disturbance, such as diminished peristalsis, the occurrence of colic, diarrhœa, etc.
It is well to remember, however, that these troubles often follow an ascitic stage, which may gradually disappear owing to the fluid becoming absorbed. Even in the fibrous form, where the intestines appear completely glued together by adhesions, the volume of the abdomen is increased and the belly is deformed, as in ascites.
In time patients suffering from primary lesions of an important internal organ are affected in their digestion, lose flesh and become anæmic, and finally cachectic.
Diagnosis. The diagnosis is by no means easy, particularly in the fibrous forms, owing to the great difficulty of discovering the primary lesion.
Prognosis. The prognosis is grave, though it must not be regarded as necessarily fatal. In cases resulting from genital diseases, and in localised chronic peritonitis resulting from persistent, but not excessive, mechanical violence, complete and perfect recovery may occur.
On the other hand, in cases of chronic lesions of the liver, kidneys, heart, etc., and in tuberculosis, carcinoma, etc., recovery cannot be expected.
Treatment. Treatment should be directed towards combatting the chronic inflammation. With this object resort may be had, when necessary, to persistent stimulation of the sides of the abdomen, mild blisters and mustard plasters, or friction with turpentine.