How can one distinguish peritonitis from bacteria in fluid caused by accidental bowel perforation?

Distinguishing peritonitis due to accidental bowel perforation from the presence of bacteria in fluid can be effectively done by examining the characteristics of the white blood cells present in the fluid. In cases of peritonitis, especially due to bowel perforation, there will typically be a strong immune response manifesting in the fluid analysis.

The correct answer highlights that the lack of phagocytized bacteria and the presence of normal white blood cells can indicate that there is not an active infectious process occurring. Normal white blood cells would suggest a non-infectious or resolving situation, whereas the presence of phagocytized bacteria would indicate an active response to infection. In peritonitis caused by bowel perforation, one would expect to see a significant number of leukocytes and possibly bacteria being engulfed, reflecting the body's attempt to fight off the infection.

In essence, observing normal white blood cells alongside a lack of phagocytized bacteria provides crucial information for diagnosing the underlying condition, differentiating between mere bacterial presence and a significant inflammatory response associated with peritonitis.