Peritonitis: Causes, Symptoms, Diagnosis, Prevention & Treatment


Peritonitis, it is an inflammation of the peritoneum, which is the thin layer of tissue that covers the inside of the abdomen and various organs within the abdomen. It usually develops from a bacterial, fungal infection. It requires a timely medical attention to treat the infection. If the inflammation is left untreated then it can spread into the blood and also to other organs, which may result in failure of multiple organs and even death.

Causes of peritonitis

There are two types of causes are primary spontaneous and secondary peritonitis. Primary peritonitis is an infection which develops in the peritoneum. Peritoneum holds the insides of the belly in their respective places. Secondary peritonitis usually develops when an injury or infection in the abdominal cavity allows contagious organisms into the peritoneum. Some of the causes of peritonitis are as follows:

  • Medical procedures: Peritoneal dialysis uses tubes to remove the waste products from the blood when the kidneys can no longer adequately do so. An infection can occur during peritoneal dialysis because of unclean surroundings, poor hygiene or infected equipment. The inflammation of the peritoneum also may expand as a problem of gastrointestinal surgery, the use of feeding tubes or a method to withdraw fluid from the abdomen and rarely as a tricky situation of colonoscopy or endoscopy.
  • Ruptured appendix, stomach ulcer: These conditions may allow the bacteria to enter the peritoneum through a hole in the gastrointestinal tract.
  • Pancreatitis: Inflammation of the pancreas, which is complicated by the infection, may lead to peritonitis if the bacteria get spread outside the pancreas.
  • Diverticulitis: The infection of small pouches in the digestive tract may cause peritonitis if the pouches rupture, spilling intestinal waste into the abdominal cavity.
  • Trauma: Any kind of serious injury or trauma can be the reason of peritonitis by letting bacteria and any chemicals from other parts of the body to enter the peritoneum.
  • A perforated colon
  • Cirrhosis or any other types of liver disease

Signs and symptoms of peritonitis

There are various signs and symptoms, which may differ depending upon the cause of the inflammation, but there are also some common symptoms which suggest that an individual may have peritonitis. Some of the common symptoms of this inflammation are as follows:

  • Abdominal pain or tenderness
  • Abdominal swelling
  • Fever and chills
  • Vomiting
  • Nausea
  • Constipation
  • Fatigue
  • Diarrhea
  • Loss of appetite
  • Decrease in urination
  • Difficulty in passing gas
  • Ascites
  • Extreme thirst
  • Fast heartbeat


If anyone has its symptoms, then the person should visit the doctor as soon as possible. Delaying the treatment could put a person’s life in danger. The doctor will ask about the medical history and perform a complete physical examination which may include assessment of tension and tenderness in the abdomen. It will help to find out the type, timing, and location of the symptoms. Medical attention is extremely important for the peritoneal dialysis patients who have a combination of abdominal pain and a clouding of the peritoneal fluid. The doctor may recommend some of the following tests to confirm the diagnosis:

  • Blood tests: Blood tests may be taken to check for a high white blood cell count. A blood culture may also be performed to determine if the bacteria are found in the blood.
  • Imaging tests: Imaging tests such as X-ray, USG or CT scan may be done for checking the holes or other perforations in the gastrointestinal tract. Abdominal X-ray will help in revealing dilated intestines and to look for pneumoperitoneum. The CT scan will be helpful in differentiating causes of abdominal pain.
  • Peritoneal fluid analysis: A sample of the fluid in the peritoneum may be taken using a thin needle. If the person has peritonitis, in the examination of the fluid may show an increased white blood cell count. It indicates an infection or inflammation.

Treatment of peritonitis

The treatment begins with the improvement of the underlying process. In most people who have peritonitis, there is a transferable source so intravenous antibiotic therapy is started immediately.

The patient also is likely to have a need of supportive care such as avoiding dehydration, avoiding pulmonary infections, which are secondary to the peritonitis, and possibly renal system support, it is especially in patients undergoing dialysis. Reducing the inflammatory response is also the part of supportive treatment. Some individuals may need percutaneous abscess drainage to enhance antimicrobial therapy. Although there are particular suggestions for antimicrobial therapy for the treatment of infectious peritonitis, optimal antimicrobial therapy should be individualized and it depends on the types of infecting organisms and their compassion to antimicrobials. Some other treatments may include:

  • Antibiotics: A course of antibiotic medication will be prescribed which will help to fight against the infection and prevent it from spreading. The type and the duration of antibiotic therapy depend upon the severity of the condition and the kind of peritonitis a person has.
  • Surgery: Surgery is necessary for removing infected tissue, to treat the underlying cause of infection and for preventing the infection from spreading.
  • Other treatments: Pain medications, supplemental oxygen, intravenous (IV) fluids or a blood transfusion may be required for the treatment and all these will depend upon the symptoms a person has.

Complications of peritonitis

The complications of the inflammation of the peritoneum can be quite a lot more serious. Some of the complications of spontaneous peritonitis are:

  • Hepatic encephalopathy: It is a loss of brain function which occurs when the liver can no longer remove toxic substances from the blood.
  • Hepatorenal syndrome: It is the progressive failure of the kidney.
  • Sepsis: It is a severe reaction which occurs when the bloodstream becomes weighed down by the bacteria.

The complications of secondary peritonitis include:

  • Septic shock: It is characterized by seriously low blood pressure.
  • Gangrenous bowel: It is a dead bowel tissue.
  • Intraperitoneal adhesions: They are bands of fibrous tissue which join abdominal organs and can also cause bowel blockage.
  • An intra-abdominal abscess: It is a collection of pus.

Preventions of peritonitis

Peritonitis can be prevented and some of its preventions are as follows:

  • Prevention of the probability of developing inflammation of the peritoneum can be done by preventing underlying causes.
  • Individuals who have obtained peritoneal dialysis should be very careful about their hand and fingernail cleanliness to avoid the risk of contamination to the dialysis catheter. The skin, contiguous to the dialysis catheter should be cleaned daily. The patients should follow the instructions given to them by their dialysis team.
  • Use of antimicrobials have been used to lessen the risk of peritonitis; on the other hand, if this technique is used, it may produce antibiotic-resistant organisms over time.
  • Individuals should discuss how to decrease or prevent the likelihood of peritonitis repetition with their healthcare professional.


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