Peritonitis is when the peritoneum the thin layer of tissue that covers the inner wall of the abdomen and abdominal organs becomes irritated or inflamed. It’s usually due to a bacterial or fungal infection, In some cases, the peritonitis could be the result of something else going on in the abdominal area, such as a burst appendix. Because the condition can be deadly if it’s left untreated, it’s important to diagnose and treat those with peritonitis as soon as possible.
There are two types of peritonitis: primary and secondary:
Primary peritonitis is caused by a spontaneous infection (not related to perforation of the peritoneum). This is the less common type and most likely to affect people with cirrhosis of the liver or ascites, such as due to alcoholism. Infection can be due to genital tract bacteria or blood-borne bacteria proliferating in the peritoneum.
Secondary peritonitis is due to the loss of integrity of the peritoneum (damage to the mucosal barrier). This is the more common type of peritonitis and is usually related to some type of trauma to the abdominal organs.
Meconium peritonitis is the type that can affect fetuses or newborns shortly after birth. This refers to inflammation and sometimes infection due to the perforation of the intestines and meconium, the fecal material that is produced in the intestines before birth.
Risk factors of Peritonitis
- A bacterial or fungal infection
- A rupture in your abdomens, such as a ruptured appendix or stomach ulcer
- A medical procedure such as peritoneal dialysis done in an unclean environment
- Surgery in your abdomen, or an injury to your abdomen
- Use of a feeding tube
- Pancreatitis (inflamed pancreas) or diverticulitis (infection in the intestine) that causes bacteria to spread
- Advanced cirrhosis (liver disease) causing fluid buildup that becomes infected with bacteria
Infectious agents including, but not limited to, bacteria and fungi cause peritonitis. Sometimes the infection begins in the peritoneum. More often, the infection spreads from another area of the body.
Some of the most common reasons infection could spread to the peritoneum include:
- Burst appendix.
- Stomach ulcer.
- Inflammation of the pancreas (pancreatitis).
- A severe abdominal injury such as a knife wound.
- Infection after abdominal surgery.
- Digestive conditions such as diverticulitis or Crohn’s disease.
- Infection can also translocate from the gut in certain conditions such as liver failure.
Symptoms of Peritonitis
Symptoms will vary depending on the underlying cause of your infection. Common symptoms of peritonitis include:
- Tenderness in your abdomen
- Pain in your abdomen that gets more intense with motion or touch
- Abdominal bloating or distention
- Nausea and vomiting
- Constipation or the inability to pass gas
- Minimal urine output
- Anorexia, or loss of appetite
- Excessive thirst
- Fever and chills
If you’re on peritoneal dialysis, your dialysis fluid may appear cloudy or have white flecks or clumps in it. You may also notice redness or feel pain around your catheter.
- Peritonitis can cause severe health problems. It can be deadly if not treated right away.
- Peritonitis can make fluid fill up in your belly or abdomen. This can cause severe fluid loss or dehydration.
- If peritonitis isn’t treated the infection can quickly spread through your body. This can create an extreme response from your infection-fighting system (immune system) called sepsis.
- Sepsis is a fast-moving, serious condition. It happens when chemicals sent into your bloodstream to fight the infection cause swelling (inflammation) over a large part of your body. This can slow blood flow and hurt your organs.
- Severe sepsis can cause your body to go into shock. It can lead to organ failure and death.
Diagnosis and test
It’s important to find out right away if you have peritonitis. It can lead to severe health problems very quickly.
Your healthcare provider will look at your past health. He or she will give you an exam. Peritonitis is often diagnosed by looking at a sample of the infected fluid taken from the belly.
Other tests you may need are:
X-rays: These imaging tests make pictures of your body’s tissues, bones, and organs.
Blood, fluid, and urine tests: These tests are done to find out what is causing the infection.
CT scans: These imaging tests use X-rays and a computer to take pictures of the body. CT scans show detailed images of any part of the body. This includes bones, muscles, fat, and organs. They are more detailed than standard X-rays.
MRI: This is an imaging test that uses a strong magnet, radio waves, and a computer.
Surgery: If you are very ill, you may have surgery to find and remove what is causing the infection.
Treatment and medications
Treatment of peritonitis requires hospitalization to prevent the risk of complications.
Use of antibiotics – A course of antibiotic medications are prescribed to fight the infection and prevent it from spreading.
Surgical treatment is carried out to remove infected tissue, especially if peritonitis is due to a ruptured appendix, stomach or colon. If part of the tissue of the peritoneum is severely damaged by infection, it needs to be surgically removed.
Drainage of pus collection within the peritoneal cavity- In some cases an abscess (pus-filled swellings) is developed in the peritoneum that needs to be drained with a needle. An ultrasound scanner is used to guide the needle to the abscess.
Further, if the patient has peritonitis, it is recommended that they receive dialysis in another way for several days while the body heals from the infection. If peritonitis persists or recurs, peritoneal dialysis is stopped entirely and is switched to a different form of dialysis.
Prevention of Peritonitis
- 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 is used, it may generate antibiotic-resistant organisms over time.
- Individuals should discuss how to decrease or prevent the likelihood of peritonitis recurrence with their health-care professional.