Intra-abdominal infection is a common problem in clinical practice. Severe cases can be complicated with sepsis, disseminated intravascular coagulation, and even multiple organ failure.

In recent years, it is generally believed that the formation of endotoxemia is the initial link of these pathological changes, and the biological effect of endotoxin is achieved through the tumor necrosis factor. Some scholars believe that the absorption of endotoxin in the early stage of peritonitis may be mainly through the portal vein, and then through the thoracic duct and lymph is an important way. In addition, absorption through the peritoneum, mucosa, and diaphragm may also exist. Qin Mingfang et al. showed that in the 58 patients with abdominal infection studied, the content of 100% endotoxin increased, 1~7 times higher than the normal level. The results confirmed that there was a significant difference in serum tumor necrosis factor between the dead and the living cases. It is thus confirmed that the level of cytokine tumor necrosis factor is indeed an important factor determining the prognosis of patients. The animal experiment of Wang Yukun et al. also showed that the serum tumor necrosis factor did increase significantly 48 hours after peritonitis was induced, and there was an extremely significant positive correlation with the level of serum glutathione aminotransferase (CPT). It was also confirmed that the levels of xanthine oxidase (XOD) and malondialdehyde (MDA) in the model tissue and liver tissue were significantly increased, while the levels of reduced glutathione (GSH) were significantly decreased. This shows that the formation of excessive oxygen free radicals and the reduction of scavenging ability is accompanied by the double changes of endotoxin in peritonitis induced by Escherichia coli.

To sum up, when bacterial peritonitis occurs in the body, if appropriate treatment measures can be selected as early as possible, antibiotics with a relatively weak ability to induce endotoxin can be used to prevent the occurrence of endotoxemia, reduce the production of tumor necrosis factor and lipid peroxide and strengthen their clearance, it may play an effective role in preventing the deterioration of the disease and promoting the recovery of the disease.

The Limulus test can accurately and rapidly determine the content of endotoxin in bleeding, which provides a simple method for guiding treatment and estimating prognosis. Clinicians should attach great importance to it.