1. Peritoneal Surgery

• Peritoneal toilet/lavage: Thorough irrigation of the peritoneal cavity with warm saline during surgery for peritonitis, anastomotic leak, or contamination - removes pus, debris, and fibrin
• Incision and closure: The peritoneum is opened as a distinct layer; during closure it is sutured separately (or incorporated in mass closure) to re-establish the peritoneal barrier
• Adhesion formation: Post-surgical adhesion between peritoneal surfaces is a major complication leading to intestinal obstruction; avoided by gentle tissue handling, adequate hemostasis, and minimizing foreign material
• Peritoneal dialysis: The peritoneum acts as a semipermeable membrane; used as an access route in renal replacement therapy
• Mesothelial sac / hernia: The parietal peritoneum advances into hernia sacs (inguinal, incisional, parastomal) and must be dealt with at the time of repair
• Retroperitoneal approach: Certain surgeries (renal, aortic) use a retroperitoneal approach to avoid entering the peritoneal cavity

2. Pelvic Abscess

• Perforated appendix (appendix often pelvic in position)
• Post-operative peritonitis / anastomotic leakage (especially after colorectal surgery)
• Fallopian tube infections (salpingitis, PID, tubo-ovarian abscess)
• Pelvic inflammatory disease

• Pelvic pain, lower back pain, pressure sensation in pelvis
• Diarrhea with passage of mucus in stools (most characteristic)
• Swinging (hectic) pyrexia, tachycardia
• Tender boggy mass on rectal or vaginal examination

• Ultrasound (first-line, especially in paediatric/pregnant)
• CT scan - confirms diagnosis, guides drainage
• Raised WBC, CRP

• Small abscess (<5 cm): IV antibiotics, serial monitoring of CRP
• Drainage is preferred: transanal or transgluteal (CT/US-guided)
• Transintestinal drainage is no longer practiced (high fistula risk)
• Laparotomy if above measures fail or patient deteriorates

3. Chylolymphatic Cyst

• Most frequently found in the mesentery of the ileum (small intestine 60%, colon 40%)
• Thin wall of connective tissue lined by flat endothelium
• Content: clear lymph or chyle (watery milk to cream in consistency)
• Usually unilocular (more often than multilocular)
• Almost invariably solitary (rare variety: myriads of cysts throughout mesentery)

• Blood supply is independent of the adjacent intestine
• Therefore, enucleation alone is possible without bowel resection (unlike enterogenous cysts)
• Presents as a slowly enlarging, mobile, non-tender abdominal mass

1. Chylolymphatic (most common)
2. Enterogenous
3. Traumatic
4. Hydatid

• Surgical enucleation (excision of the cyst without bowel resection) - owing to its independent blood supply

RGUHS Exam Tip: For 3-mark questions, write 3-5 focused points covering definition, key features, and management. Avoid lengthy paragraphs - use point format as above.