- The definition of peritonitis is
inflammation of the peritoneal membranes.
- The signs and symptoms of peritonitis
mainly abdominal pain or discomfort but may include many others such as
- The causes of peritonitis are usually
infectious bacteria that may include underlying conditions such as
- The most common type of peritonitis is
secondary peritonitis caused by perforation of an organ in the abdomen (for
example, abdominal perforation by stabbing, ruptured appendix, and many others);
spontaneous bacterial peritonitis (SBP) also is relatively common.
- Peritonitis may be treated by many
different specialists depending upon its underlying cause.
- Peritonitis is diagnosed by the patient's
history, physical exam, and examination of fluid and the abdominal cavity for
CT scan of the abdomen also
may be ordered.
- The treatment for peritonitis usually
involves treating the underlying cause and removing the cause of the
inflammation. Most patients with peritonitis are treated with antibiotics.
- The complications of peritonitis may
include sepsis, dehydration,
hepatic encephalopathy, shock and even death.
- Peritonitis can be prevented by
eliminating the underlying causes and, in some individuals, by antibiotic
- The prognosis for a person with
peritonitis depends on its underlying cause and/or how rapidly the patient is
effectively treated, especially for infectious bacteria. The prognosis may
range from good (appendicitis, for example) to poor (hepatorenal syndrome).
What is peritonitis?
The definition of peritonitis is as follows: inflammation of the peritoneum
(the thin layer of tissue covering the inside of the abdomen and various organs
within the abdomen). Peritonitis usually develops from a bacterial or less
frequently, fungal infection; but there are other less often encountered causes
of peritoneal inflammation.
Most individuals need quick or emergent treatment of
peritonitis due to infection because infecting organisms can spread rapidly in
individuals and become life-threatening.
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Causes of Abdominal Pain
The term abdominal pain generally is used to describe pain that originates from organs within the abdominal cavity.
There are numerous causes of abdominal pain, and include, but are not limited to:
- Indigestion after eating
- Gallstones and gallbladder inflammation (cholecystitis)
- Inflammatory bowel disease (ulcerative colitis and Crohn's disease)
What are the signs and symptoms of peritonitis?
The signs and symptoms of peritonitis may vary depending upon the cause of
the inflammation; however, there are relatively common indicators that suggest
a person may have peritonitis. People usually have abdominal discomfort
and one or more of the following:
What are the causes of peritonitis?
The causes of peritonitis can be grouped into five categories. The following
is a list of these categories and some examples of their causes:
- Primary peritonitis: Spontaneous
bacterial peritonitis (SBP) is associated with ascites from patients with
cirrhosis (highest risk patients for SBP),
heart failure, or patients with
systemic lupus and nephrosis.
Over 90% of the cases are caused by a microbial infection.
- Secondary peritonitis: Secondary peritonitis is caused by
infection due to a perforated
appendix, perforated ulcers,
or bowel strangulation.
- Tertiary peritonitis: Tertiary peritonitis is caused by the bacterium Mycobacterium tuberculosis (TB),
and is referred to as tuberculosis
- Chemical peritonitis (also termed
sterile peritonitis): Chemical peritonitis is caused by leakage of sterile fluids that are irritants to the
peritoneum; for example, bile, blood, or barium used as a contrast agent during
procedures and tests.
Peritoneal abscess: Peritoneal abscess is caused by an infected fluid
collection that is encapsulated and/or adjacent to visceral organs and/or the
Some health-care professionals choose not to categorize peritonitis; they
simply use a modifier placed in front of or behind the term "peritonitis" to
describe the patient's disease. Below are definitions of a sampling of some of these terms:
- Bacterial peritonitis: any type of
peritonitis including spontaneous bacterial peritonitis caused by a bacterial
caused by leakage of the intestinal contents from the appendix.
- Acute peritonitis: initial rapid onset
of peritonitis symptoms.
- Meconium peritonitis: fetal stool that
escapes from fetal bowel prior to birth by rupture and results in sterile
- Bile peritonitis: leakage of bile
fluid into the peritoneum.
- Septic peritonitis: infection of the
peritoneum that has spread to the blood.
- Sclerosing peritonitis: inflammation
of the visceral and parental surfaces of the abdominal cavity characterized by
fibrous thickening of the peritoneum.
- Pelvic peritonitis: inflammation
involving the peritoneum surrounding the uterus and Fallopian tubes.
- Tuberculosis peritonitis: inflammation
of the peritoneum by Mycobacterium bacteria.
- Ascites peritonitis: infection of
ascites fluid causing inflammation of the peritoneum.
- Peritonitis sintomas: Spanish for
What is the most common type of peritonitis?
Most common type of peritonitis is secondary peritonitis, usually caused by a
leakage or perforation of abdominal organ like the appendix. However, another
common type of peritonitis is spontaneous bacterial peritonitis (SBP) that is
most often associated with individuals that have abdominal ascites fluid.
What kind of doctor treats peritonitis?
Peritonitis can rapidly develop into a life-threatening problem. Depending on
its cause many different doctors will be involved in the treatment;
consequently, peritonitis is seen and treated by
emergency medicine doctors,
critical-care specialists, dialysis specialists, infectious disease specialists,
gastroenterologists, hospitalists, internal medicine specialists, and
surgeons. Other specialists may need to treat underlying causes.
How is peritonitis diagnosed?
Because peritonitis can be life-threatening, early diagnosis is important.
Health-care professionals will take a history and perform a physical exam on the
patient. They also may ask for details about
dialysis, ascites, trauma to the abdomen.
The patient may have some mild discomfort while the doctor examines his/her abdomen.
Tests that may be ordered include a complete cell count (CBC),
blood cultures, and imaging tests such as a ultrasound or CT scan of the abdomen/pelvis.
Some patients that do peritoneal dialysis will be asked for a sample of the dialysis
fluid so that it can be examined. In some patients with abscesses, examination
of the abscess fluid is done.
What is the treatment for peritonitis?
The treatment for peritonitis begins with correction of the underlying
process (for example, appendicitis that has caused peritonitis or bile leakage
into the abdominal cavity). In most people with peritonitis there is an
infectious source so intravenous antibiotic therapy is started immediately.
The patient also is likely to require supportive care such as avoiding
dehydration, avoiding pulmonary infections that are secondary to the peritonitis,
and possibly renal system support (especially in patients undergoing dialysis).
Reducing the inflammatory response also may be part of supportive treatment.
Some individuals may require percutaneous abscess drainage to augment
antimicrobial therapy. Although there are specific suggestions for antimicrobial
therapy for treating infectious peritonitis, optimal antimicrobial therapy
should be individualized and depends on the types of infecting organisms and
their sensitivity to antimicrobials.
What are the complications of peritonitis?
The complications of peritonitis can be extremely serious, and include
- multiple organ infection and/or failure,
- hepatic encephalopathy,
- hepatorenal syndrome (liver disease leading to increasing
Can peritonitis be prevented?
- Prevention or reduction in the chance of developing peritonitis can be done
by preventing underlying causes (for example, trauma, ulcers, alcoholic
cirrhosis, and pelvic inflammatory disease).
- Individuals that are obtaining
peritoneal dialysis should be very careful about hand and fingernail cleanliness to
avoid contamination to the dialysis catheter. Skin adjacent to the dialysis
catheter should be cleaned daily, and patients should follow instructions given
to them by their dialysis team.
- Preventive use of antimicrobials have been used to reduce the risk
peritonitis; however, if this technique if used it may generate antibiotic resistant
organisms over time.
- Individuals should discuss how to decrease or prevent likelihood of
peritonitis recurrence with their health-care professional.
What is the prognosis for a person with peritonitis?
The prognosis for individuals who develop peritonitis depends on both the
underlying cause and how rapidly the disease is treated. The prognosis can range
from good to poor. For example, individuals that are treated appropriately with
antimicrobials and surgery for peritonitis caused by appendicitis often have a
good outcome. However, individuals with long-standing disease such as
failure that develop the hepatorenal syndrome and peritonitis have a poor
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Medically Reviewed on 5/11/2016
Daley, B. "Peritonitis and Abdominal Sepsis." Medscape. Updated Feb 23, 2015.