Peritonitis: Causes, Symptoms, Diagnosis, Treatment, Complications, Prevention and Perspectives

It is the inflammation of the peritoneum, the thin layer of tissue that covers the inside of your abdomen and most of your organs.

The inflammation is usually the result of a fungal or bacterial infection. This can be caused by an abdominal injury, an underlying medical condition, or a treatment device, such as a dialysis catheter or a feeding tube.

Peritonitis is a severe illness that needs immediate medical attention. Antibiotics are required intravenously (IV) to treat the infection.

Surgery is sometimes necessary to remove the infected tissue. The infection can spread and endanger life if not treated promptly.

Quick Facts about Peritonitis

  • Peritonitis is an infection of the lining of the stomach.
  • It can cause bloating and severe stomach pain. Peritonitis is considered a medical emergency.
  • The condition can be diagnosed using CT scans, ultrasounds, and blood tests.
  • An injury or infection can cause Peritonitis.
  • It is treated with IV antibiotics or surgery, depending on the cause.

What is the Peritoneum?

The abdominal cavity contains the main parts of the intestine, such as the stomach and intestines. It also has other organs such as the liver and kidneys.

The peritoneum covers the abdominal wall but also forms folds that go inward. When folded, the peritoneum is woven between the abdominal organs, providing a membrane that protects and stabilizes the organs in the abdomen.

The folds of the peritoneum also contain blood and nerve supplies. These vessels can be seen running through the membrane that secures the intestines.


What causes Peritonitis?

There are two types of Peritonitis. Spontaneous bacterial Peritonitis (SBP) or spontaneous primary Peritonitis, an infection that develops in the peritoneum, results from an infection of the fluid in the cavity. Kidney or liver failure can cause this condition.

People on peritoneal dialysis due to kidney failure also have an increased risk of spontaneous bacterial Peritonitis. Secondary Peritonitis is usually due to an infection that has spread from the digestive tract.

Both types of Peritonitis are life-threatening. The death rate from Peritonitis depends on many factors, but it can be as high as 40% in cirrhosis patients. Up to 10% can die of secondary Peritonitis.

The most common risk factors for primary spontaneous Peritonitis include:

Liver disease with cirrhosis. This disease often causes an accumulation of abdominal fluid ( ascites ) that can become infected.

Renal insufficiency in peritoneal dialysis: this technique, which involves the implantation of a catheter in the peritoneum, is used to eliminate waste products in the blood of people with kidney failure.

It is related to an increased risk of Peritonitis due to accidental contamination of the peritoneum through the catheter.

The following standard conditions and causes can lead to Peritonitis:

  • A wound or abdominal injury.
  • A broken appendix.
  • A stomach ulcer
  • A perforated colon.
  • Diverticulitis.
  • Pancreatitis or inflammation of the pancreas.
  • Cirrhosis of the liver or other types of liver disease.
  • Infection of the gallbladder, intestines, or bloodstream.
  • Pelvic inflammatory disease (PID).
  • Crohn’s disease .
  • Invasive medical procedures, including the treatment of kidney failure, surgery, or a feeding tube.

Noninfectious causes of Peritonitis include irritants such as bile, blood, or foreign substances in the abdomen, such as barium.

Symptoms of Peritonitis

The symptoms of Peritonitis are severe. They need urgent medical attention in a nearby emergency room or an ambulance call. People who develop Peritonitis while in the hospital need urgent care.

The main symptom is a sudden and severe stomach pain that gets worse. Some effects of Peritonitis are related to the severe impacts on the body, such as dehydration and shock.

The symptoms will vary depending on the underlying cause of your infection. Common signs of Peritonitis include:

  • Abdominal sensitivity or tenderness at the point of your abdomen.
  • Pain in your stomach becomes more intense with movement or touch.
  • Abdominal distension.
  • Nausea and vomiting.
  • Diarrhea.
  • Constipation or the inability to pass gas.
  • Minimum urinary output
  • Anorexia or loss of appetite.
  • Sed excess.
  • Fatigue.
  • Fever and chills.

If you are on peritoneal dialysis, your dialysis fluid may appear cloudy or have white dots or lumps. You may also notice redness or pain around the catheter.

It is essential to get medical help for these symptoms, whether related to Peritonitis or not. Doctors will want to rule out Peritonitis or treat other life-threatening conditions.

Swollen abdomen

A swollen abdomen is also a symptom of Peritonitis. When a rupture causes Peritonitis, the fluid fills the abdominal cavity and intestine, resulting in fluid loss from the rest of the body. This causes the worst effects of dehydration of Peritonitis.

When liver disease is the cause of Peritonitis, a swollen abdomen can occur for a different reason. This usually occurs without the perforation seen in other types of Peritonitis. This is known as spontaneous bacterial Peritonitis.

This form of Peritonitis has different symptoms. Discomfort is the main symptom of spontaneous bacterial Peritonitis due to the pressure of the fluid increase.

The pain is mild to moderate, not severe for people with liver disease whose swollen abdomens become infected.

Diagnosing Peritonitis

If you have symptoms of Peritonitis, seek medical attention immediately; seeking immediate medical attention is especially important for peritoneal dialysis patients who have a combination of abdominal pain and peritoneal fluid opacity.

This combination is caused by an accumulation of white blood cells that fight infections.

Delaying your treatment could put your life at risk because Peritonitis can quickly lead to potentially fatal complications.

Complications such as sepsis and septic shock, which cause a massive drop in blood pressure, organ failure, and death, it is essential to receive a rapid diagnosis followed by appropriate treatment.

Your doctor will ask about your symptoms and medical history and perform a complete physical exam. This will include touching or pressing on your abdomen, which will probably cause some discomfort.

Several other tests can help your doctor diagnose Peritonitis:

A blood test called a complete blood count (CBC) can measure your white blood cell count (WBC). A high white blood cell count usually indicates inflammation or infection. A blood culture can help identify the bacteria that cause the disease or inflammation.

If you accumulate fluid in your abdomen, your doctor may use a needle to extract a little and send it to a laboratory for fluid analysis. Making a culture of the liquid can also help identify bacteria.

In exploratory surgery, your doctor can also perform a paracentesis, in which fluid is removed from the abdominal cavity through a thin needle and checked for infection.

Paracentesis helps identify primary spontaneous Peritonitis and secondary Peritonitis caused by pancreatitis; this involves taking fluid from the abdomen to check for infection. A thin needle is inserted through the abdominal wall under local anesthesia.

The fluid is then analyzed for signs of inflammation and infection.

Excess fluid in the abdomen can fill the abdominal cavity between the organs. Doctors call this condition ascites, and the fluid is known as ascitic fluid.

The test includes sending the fluid sample to analyze white blood cell counts and chemicals. The laboratory can also search for bacteria and other microbes under the microscope or using spots and cultures. Not all cases of Peritonitis require paracentesis.

Having fluid in your abdomen can be the reason for visiting the hospital in the first place. This extra fluid is more common in people who have liver disease.

Spontaneous bacterial Peritonitis is found in approximately 20 percent of people admitted to the hospital with ascites due to liver cirrhosis.

Imaging tests, such as CT scans and x-rays, can show any perforation or hole in the peritoneum.

If you are on dialysis, your doctor can diagnose Peritonitis based on the appearance of cloudy dialysis fluid.

How Peritonitis is treated

The first step in treating Peritonitis is to determine its underlying cause. The treatment usually includes antibiotics to fight infections and pain medications.

If you have infected intestines, an abscess, or an inflamed appendix, you may need surgery to remove the infected tissue; you will be admitted to a hospital. Usually, you will immediately start receiving intravenous antibiotics or antifungal medications to treat the infection.

Additional supportive treatments will be needed if the organic failure of sepsis develops as a complication of the infection. These treatments may include intravenous fluids, medications to maintain blood pressure, and nutritional support.

If you are on renal dialysis and have Peritonitis, you may have to wait until the infection clears up to receive more dialysis. If the condition continues, you may need to switch to another type of dialysis, such as hemodialysis.

You can receive medications that are injected directly into the peritoneal tissue, a strategy that, according to some studies, is more effective than intravenous medications.

Your treatment should start immediately to avoid severe and potentially fatal complications.

In many cases, emergency surgery is required, mainly if the Peritonitis has been caused by conditions such as appendicitis, a perforated stomach ulcer, or diverticulitis.

Infected tissue will be removed surgically, such as a bursting appendix or abscess. So will any part of the peritoneal tissue that the infection has seriously damaged.

During your hospitalization, you will be closely monitored for signs of sepsis and septic shock, which usually require an immediate transfer to an intensive care unit.

Complications of Peritonitis

If not treated promptly, the infection can enter the bloodstream and cause shock and damage to other organs. This can be fatal. Possible complications of spontaneous Peritonitis include:

  • Hepatic encephalopathy is a loss of brain function when the liver can no longer remove toxic substances from its blood.
  • Hepatorenal syndrome: is progressive renal failure.
  • Sepsis: is a severe reaction that occurs when the bloodstream is overwhelmed by bacteria.

Complications of secondary Peritonitis include:

  • An intra-abdominal abscess.
  • Gangrenous intestine, which is dead intestinal tissue.
  • Intraperitoneal adhesions are bands of fibrous tissue that attach to the abdominal organs and can cause intestinal blockage.
  • Septic shock is characterized by dangerously low blood pressure.

How to Prevent Peritonitis

On dialysis, wash your hands and fingernails before touching the catheter. Clean the skin around the catheter daily. Follow your doctor’s instructions regarding the care and storage of your medical supplies.

Although Peritonitis can be a complication of peritoneal dialysis, it is much less common than it used to be due to the improved technology and self-care techniques taught during initial training.

Immediately inform your peritoneal dialysis nurse about any possible contamination of your dialysis fluid or catheter. A single dose of antibiotics can prevent contamination from becoming an infection in many cases.

If you have severe abdominal pain or an abdominal injury, such as a knife wound, take one of the following measures:

  • See your doctor.
  • Go to an emergency room.
  • Call local emergency services.

Long-term Perspectives for Peritonitis

The prognosis for Peritonitis depends on the cause of your infection and how much progressed before the treatment began. Medications and surgery can usually control the disease.

If the treatment does not start early, the infection may spread. If other organs are damaged, your recovery will depend on your general health and the damage you have suffered.

Peritonitis can lead to more dangerous conditions without immediate treatment, such as sepsis and septic shock. As a result, the state can quickly become a threat to life.