Peritonitis

Peritonitis is a serious inflammation of the peritoneum, the thin tissue lining the inside of your abdomen and covering your abdominal organs. It usually happens because of a bacterial or fungal infection. This condition causes severe abdominal pain and requires immediate medical attention and treatment, often involving antibiotics and sometimes surgery, to prevent life-threatening complications.

What is Peritonitis?

Peritonitis is a serious inflammation of the peritoneum, the thin membrane that lines the inside of your abdomen and covers your abdominal organs. It typically occurs when bacteria or fungi infect this lining, often due to a ruptured organ or other abdominal problem. Because it can quickly lead to severe complications, peritonitis requires urgent medical care.

The peritoneum is a vital protective layer. It acts like a sac that holds your abdominal organs in place and helps them move smoothly against each other. When this lining becomes inflamed, it can cause intense pain and other symptoms throughout your abdomen. There are two main types of peritonitis. Primary peritonitis, also called spontaneous bacterial peritonitis (SBP), happens without an obvious source of infection in the abdomen. It usually affects people with severe liver disease and fluid buildup in the abdomen (ascites). Secondary peritonitis is more common and occurs when an infection spreads from an organ inside the abdomen, such as a burst appendix or a hole in the bowel. Both types are serious and need prompt treatment.

Symptoms

Peritonitis typically causes severe abdominal pain that can worsen with movement or touch. Other common symptoms include bloating, fever, nausea, and vomiting. You might also experience a loss of appetite, diarrhea, or a decrease in how much you urinate. These symptoms usually appear suddenly and indicate a serious medical emergency.

The most noticeable symptom of peritonitis is often sudden, severe abdominal pain. This pain can spread across your entire abdomen and usually gets worse when you move, cough, or press on your stomach. Your abdomen might feel very tender and rigid, sometimes described as "board-like." Along with pain, you may develop a fever, which is your body's response to infection. Nausea and vomiting are also common, making it difficult to eat or drink. Some people experience bloating, where their abdomen feels swollen and full, or changes in bowel habits like diarrhea. You might also feel very thirsty and notice you are urinating less than usual. If you experience these symptoms, especially severe abdominal pain, seek medical help immediately.

Causes & risk factors

Peritonitis is usually caused by an infection from bacteria or fungi. This can happen when an abdominal organ ruptures, like a burst appendix or a perforated ulcer, or from complications of other medical conditions. Certain health issues, such as liver disease with fluid buildup (ascites) or undergoing peritoneal dialysis, increase your risk of developing peritonitis.

The causes of peritonitis are generally divided into two main categories: **Secondary Peritonitis:** This is the most common type and occurs when bacteria or fungi enter the peritoneum from an infection or injury within the abdomen. Common causes include: * **Ruptured appendix:** An inflamed appendix can burst, spilling infection into the abdomen. * **Perforated stomach ulcer:** A hole in the stomach lining can allow digestive fluids and bacteria to leak out. * **Perforated colon:** A tear or hole in the large intestine, often due to diverticulitis (inflamed pouches in the colon), can release bacteria. * **Pancreatitis:** Inflammation of the pancreas can release digestive enzymes that irritate the peritoneum. * **Trauma or surgery:** Injuries to the abdomen or complications from abdominal surgery can introduce bacteria. * **Peritoneal dialysis:** This kidney treatment involves a catheter in the abdomen, which can sometimes become infected. **Primary Peritonitis (Spontaneous Bacterial Peritonitis – SBP):** This type develops without an obvious source of infection within the abdomen. It is a common complication for people with severe liver disease, especially cirrhosis, who have a buildup of fluid in their abdomen (ascites). The fluid can become infected with bacteria that have traveled from the bloodstream or lymphatic system. Risk factors for peritonitis include having liver disease with ascites, undergoing peritoneal dialysis, a history of appendicitis, diverticulitis, or peptic ulcers. Any condition that can lead to a rupture or leak in an abdominal organ increases your risk.

How it's diagnosed

Diagnosing peritonitis involves a physical exam, blood tests, and imaging scans to identify inflammation and the source of infection. Your doctor will check for tenderness and rigidity in your abdomen. They may also analyze a sample of fluid from your abdomen to confirm an infection and determine the specific type of bacteria or fungi causing it.

When you arrive at the hospital, a doctor will perform a thorough physical examination. They will gently press on your abdomen to check for tenderness, swelling, and rigidity, which are key signs of peritonitis. They will also listen to your bowel sounds. Several tests help confirm the diagnosis: * **Blood tests:** These can show signs of infection, such as an elevated white blood cell count. They can also check for organ function, like liver or kidney problems, which might be related to the cause. * **Imaging tests:** X-rays, computed tomography (CT) scans, or ultrasounds of your abdomen can help identify the source of the infection, such as a ruptured appendix or a hole in the bowel. These scans can also show fluid buildup or abscesses (pockets of pus). * **Peritoneal fluid analysis (paracentesis):** In this procedure, a thin needle is used to remove a small sample of fluid from your abdomen. This fluid is then sent to a lab to check for bacteria, white blood cells, and other signs of infection. This test is crucial for diagnosing spontaneous bacterial peritonitis (SBP) and guiding antibiotic treatment. Combining these diagnostic methods helps your medical team quickly and accurately determine if you have peritonitis and what is causing it, which is vital for starting the correct treatment.

Treatment options

Treatment for peritonitis focuses on controlling the infection and addressing its underlying cause. This typically involves strong antibiotics given intravenously to kill bacteria or fungi. In many cases, surgery is also necessary to repair any ruptured organs, remove infected tissue, or drain pus from the abdomen. Supportive care, like pain relief and fluids, is also crucial.

Because peritonitis is a life-threatening condition, treatment usually begins immediately, often before the exact cause is fully known. The primary goals are to eliminate the infection and fix any underlying problem. **Antibiotics:** You will typically receive broad-spectrum antibiotics through a vein (intravenously) right away. These medications are designed to kill a wide range of bacteria or fungi that commonly cause peritonitis. Once the specific germ causing your infection is identified from fluid samples, your doctor may adjust the antibiotics to target it more precisely. **Surgery:** For secondary peritonitis, surgery is often essential. The type of surgery depends on the cause but may include: * **Repairing a rupture:** For example, closing a hole in the stomach or bowel. * **Removing infected tissue:** Such as an inflamed appendix. * **Draining pus:** Cleaning out infected fluid or abscesses from the abdominal cavity. * **Peritoneal lavage:** Washing out the abdominal cavity with sterile fluid. Surgery helps remove the source of infection and clean the peritoneum, allowing it to heal. **Supportive Care:** While antibiotics and surgery address the infection, supportive treatments are also vital. These include intravenous fluids to prevent dehydration, medications to manage pain and nausea, and nutritional support. For people on peritoneal dialysis, the dialysis catheter may need to be removed and replaced after the infection clears.

Recovery & outlook

Recovery from peritonitis depends heavily on the cause, how quickly treatment begins, and your overall health. With prompt and effective treatment, many people recover fully. However, peritonitis is a serious condition that can lead to severe complications like sepsis or organ failure if not treated quickly. Your medical team will monitor you closely during and after treatment.

The outlook for peritonitis varies greatly. If diagnosed and treated quickly, especially with antibiotics and surgery when needed, the chances of a good recovery are much higher. Delay in treatment significantly increases the risk of severe complications. Potential complications of peritonitis include: * **Sepsis:** A life-threatening response to infection that can lead to organ damage. * **Abscesses:** Pockets of pus that can form in the abdomen. * **Organ failure:** Severe infection can impact the function of organs like the kidneys or liver. * **Adhesions:** Scar tissue that can form between abdominal organs, potentially causing future problems. After initial treatment, you may need a period of recovery in the hospital. This could involve continued intravenous antibiotics, pain management, and monitoring for any signs of complications. For those who underwent surgery, recovery will also involve healing from the surgical procedure. Your doctor will provide specific guidance on activity levels, diet, and follow-up care. It is crucial to follow all medical advice to ensure a full recovery and prevent recurrence.

When to see a doctor

Peritonitis is a medical emergency requiring immediate attention. You should seek urgent medical care if you experience sudden, severe abdominal pain, especially if it's accompanied by tenderness, bloating, fever, nausea, or vomiting. Do not delay seeking help, as prompt diagnosis and treatment are crucial to prevent life-threatening complications and improve your chances of recovery.

Peritonitis can rapidly become life-threatening, so it's essential to recognize the warning signs and act quickly. If you experience any of the following symptoms, go to an emergency room or call for emergency medical help immediately: * Sudden, severe abdominal pain that worsens with movement or touch. * A rigid or "board-like" abdomen. * Abdominal tenderness or bloating. * Fever and chills. * Nausea and vomiting. * Loss of appetite. * Reduced urine output. These symptoms indicate a serious problem that needs urgent medical evaluation. Do not try to treat these symptoms at home or wait to see if they improve. Prompt medical attention can significantly improve your outcome and prevent serious complications like sepsis or organ failure. If you are undergoing peritoneal dialysis and notice any signs of infection around your catheter site or cloudy dialysis fluid, contact your medical team right away.

Frequently asked questions

Can peritonitis be prevented?

While not all cases are preventable, you can reduce your risk, especially if you have certain conditions. For people undergoing peritoneal dialysis, strict hygiene and proper technique are crucial to prevent catheter-related infections. Managing underlying conditions like diverticulitis or ulcers can also help prevent ruptures that lead to peritonitis.

Is peritonitis always caused by an infection?

Peritonitis is almost always caused by a bacterial or fungal infection. These infections can arise from a ruptured abdominal organ, complications of surgery, or, in some cases, spontaneously in people with liver disease and fluid buildup in the abdomen (ascites).

How long does it take to recover from peritonitis?

Recovery time varies widely depending on the cause of peritonitis, its severity, and how quickly treatment was started. Mild cases treated promptly might resolve in a few days to a week, while more severe cases requiring surgery and extensive hospital stays could take several weeks or even months for full recovery.

Can peritonitis recur?

Yes, peritonitis can recur, especially if the underlying cause is not fully resolved or if you have ongoing risk factors. For example, people on peritoneal dialysis are at risk of recurrent infections if proper hygiene isn't maintained. Individuals with liver disease and ascites may also experience repeat episodes of spontaneous bacterial peritonitis (SBP).

What is the difference between primary and secondary peritonitis?

Primary peritonitis (spontaneous bacterial peritonitis or SBP) occurs without an obvious source of infection within the abdomen, often in people with liver disease and fluid buildup (ascites). Secondary peritonitis, which is more common, results from an infection that spreads from an abdominal organ, such as a ruptured appendix or a perforated ulcer.

Are there long-term effects of peritonitis?

If treated promptly and effectively, many people recover without long-term effects. However, severe cases or delayed treatment can lead to complications such as abdominal adhesions (scar tissue), chronic pain, or, in rare instances, ongoing organ damage. Regular follow-up with your doctor is important to monitor for any lasting issues.

Sources

• MedlinePlus — Peritonitis
• Mayo Clinic — Peritonitis
• Cochrane Library — Peritonitis