Peritonitis

Understanding the early signs and risk factors of peritonitis can help in early diagnosis and timely treatment. This comprehensive guide covers everything you need to know about peritonitis—its symptoms, types, causes, diagnosis, treatment options, complications, and prevention.

What is Peritonitis?

Peritonitis refers to inflammation of the peritoneum, the protective lining of the abdomen. It can affect part of the abdomen or spread throughout the entire abdominal cavity. The condition can develop suddenly (acute peritonitis) or gradually (chronic peritonitis).

Peritonitis is considered a medical emergency because the infection can quickly enter the bloodstream and result in septic shock, a life-threatening condition.

Types of Peritonitis

There are three major types:

1. Primary Peritonitis (Spontaneous Bacterial Peritonitis – SBP)

This form typically occurs in people with:

• Liver cirrhosis

• Ascites (fluid in the abdomen)

• Kidney failure

It is usually caused by bacteria entering the peritoneal cavity from the bloodstream or lymphatic system rather than from a perforation.

2. Secondary Peritonitis

This is the most common type and occurs when an infection or leakage originates within the abdominal organs.

Common causes include:

• Ruptured appendix

• Perforated peptic ulcer

• Diverticulitis

• Pancreatitis

• Trauma or injury

• Bowel obstruction

• Leakage after abdominal surgery

3. Tertiary Peritonitis

A persistent or recurrent infection that may occur even after appropriate treatment. It is usually seen in:

• Immunocompromised patients

• Patients in intensive care

• Those with severe underlying illnesses

Symptoms of Peritonitis

The symptoms may differ based on the underlying cause but commonly include:

1. Mild to Severe Abdominal Pain

Abdominal pain is usually intense, sharp, and worsens with movement or touch. Patients often avoid movement to reduce discomfort.

2. Swollen and Distended Abdomen

The abdomen may appear enlarged due to the buildup of pus, air, infection, or fluid.

3. Dehydration

Symptoms like dry mouth, low urine output, and extreme thirst may occur due to vomiting or infection.

4. Temporary Bowel Paralysis (Ileus)

The intestines may stop functioning, leading to:

• Constipation

• Inability to pass gas

• Abdominal bloating

If you have an infection, you may also experience:

• Fever

• Nausea and vomiting

• Fast heart rate

• Shortness of breath

• Chills

• Fatigue or weakness

Untreated peritonitis can quickly lead to systemic infection and sepsis.

Causes of Peritonitis

The condition occurs when bacteria, fungi, or chemical irritants enter the peritoneal space.

Common Causes Include:

1. Perforation of Abdominal Organs

A hole or rupture in the stomach, intestines, or colon can allow digestive juices and bacteria to leak into the abdomen.

Examples:

• Peptic ulcer perforation

• Ruptured appendix

• Traumatic bowel perforation

2. Infections

• Pelvic inflammatory disease

• Tuberculosis in rare cases (TB peritonitis)

• Spontaneous bacterial infection in people with cirrhosis

3. Medical Procedures

• Dialysis catheter infections (particularly in peritoneal dialysis patients)

• Post-surgical complications

• Endoscopic procedures

4. Injury or Trauma

Accidents, stab wounds, and blunt force trauma can tear abdominal organs or introduce bacteria.

Diagnosis of Peritonitis

Early diagnosis is crucial for preventing complications. Doctors use a combination of physical examination, imaging tests, and laboratory tests.

1. Physical Examination

• Severe tenderness

• Guarding (abdominal muscles stiffen)

• Rebound tenderness

• Abdominal distension

2. Blood Tests

• Elevated white blood cell count

• Elevated CRP

• Signs of sepsis

3. Imaging Tests

• Ultrasound: Detects fluid accumulation

• CT Scan: Identifies perforations, abscesses, obstructions

• X-ray: Shows air under the diaphragm indicating perforation

4. Paracentesis

A sample of abdominal fluid is drawn to check for:

• Bacteria

• White blood cells

• Protein levels

Treatment of Peritonitis

Treatment must begin immediately. The approach depends on the cause and severity.

1. Antibiotic Therapy

Broad-spectrum antibiotics are started immediately to control infection. Once the specific bacteria are identified, targeted antibiotics are used.

2. Surgery

Emergency surgery may be required for:

• Appendicitis

• Perforated ulcers

• Ruptured intestines

• Peritonitis due to trauma

• Abscess drainage

3. Fluid Replacement

IV fluids help stabilize blood pressure and prevent dehydration.

4. Pain Management

Analgesics may be administered, but only after diagnosis to avoid masking symptoms.

5. Peritoneal Dialysis Catheter Removal

If the infection is caused by a contaminated catheter, it may need removal.

Possible Complications of Peritonitis

If not treated quickly, peritonitis can lead to:

• Sepsis

• Septic shock

• Organ failure

• Kidney damage

• Scar tissue formation in the abdomen

• Chronic digestive issues

• Death

The risk increases significantly when treatment is delayed.

Prevention of Peritonitis

While not all cases can be prevented, certain steps can reduce the risk:

1. Manage Chronic Diseases

• Treat cirrhosis early

• Manage kidney disease

• Control diabetes

2. Avoid Peritoneal Dialysis Contamination

• Maintain hygiene

• Follow proper catheter care techniques

• Wear sterile gloves

3. Prompt Treatment of Abdominal Pain

Never ignore severe or sudden abdominal pain—it can be a sign of perforation or infection.

4. Safe Surgical Practices

Ensuring sterile techniques during surgeries reduces postoperative infection risks.

Diet and Lifestyle Tips for Recovery

After treatment for peritonitis, patients should:

• Drink plenty of fluids

• Follow a soft or liquid diet initially

• Avoid spicy and fatty foods

• Include probiotics after consulting a doctor

• Avoid alcohol, especially in liver disease

immediate medical help if you experience:

• Severe abdominal pain

• Persistent vomiting

• Fever with abdominal swelling

• Difficulty breathing

• Rapid heartbeat

• Signs of shock (cold skin, confusion, fainting)

FAQs on Peritonitis

1. Is peritonitis life-threatening?

Yes. Peritonitis is a medical emergency that requires prompt treatment to prevent sepsis and organ failure.

2. Can peritonitis heal on its own?

No. It always requires medical treatment such as antibiotics or surgery.

3. What is spontaneous bacterial peritonitis (SBP)?

SBP occurs without an obvious cause and is common in people with liver cirrhosis and ascites.

4. What does peritonitis pain feel like?

It is usually severe, sharp, and worsens with movement or touch.

5. How is peritonitis confirmed?

Doctors use clinical examination, imaging (CT scan or ultrasound), and abdominal fluid tests.

6. Can peritonitis return?

Yes, especially in people with chronic liver disease or those undergoing peritoneal dialysis.

7. What foods should be avoided during recovery?

Avoid spicy foods, alcohol, oily dishes, and high-fat meals.

8. Is peritonitis contagious?

No, but the underlying infections causing it may spread.

Peritonitis is a severe condition that demands early detection and urgent treatment. Recognizing symptoms like severe abdominal pain, swelling, fever, or dehydration can help in seeking timely medical help. With prompt diagnosis, antibiotics, surgery when needed, and proper supportive care, patients can recover fully. Maintaining good hygiene, managing chronic diseases, and following medical guidance can significantly reduce the risk of developing peritonitis.

If you or a loved one experiences sudden abdominal symptoms, consult a healthcare professional immediately.