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Peritonitis Main Page

Patient Information

Overview

Causes

Classification

Spontaneous Bacterial Peritonitis
Secondary Peritonitis

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Causes


Common causes Less common causes
Spontaneous bacterial peritonitis
Secondary peritonitis


Classification

Peritonitis is classified based on the cause of the inflammatory process and the character of microbial contamination as follows:[1][2][3]

 
 
 
 
 
 
 
 
Peritonitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Primary peritonitis
 
 
 
 
Secondary peritonitis
 
 
 
 
Tertiary peritonitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Spontaneous peritonitis
❑ Peritonitis in patients with CAPD
❑ Tuberculous peritonitis
 
 
 
 
 
 
 
 
 
 
 
 
❑ Peritonitis without evidence for pathogens
❑ Peritonitis with fungi
❑ Peritonitis with low-grade pathogenic bacteria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute perforation peritonitis
❑ Gastrointestinal perforation
❑ Intestinal ischemia
❑ Pelviperitonitis and other forms
 
 
Postoperative peritonitis
❑ Anastomotic leak
❑ Accidental perforation and devascularization
 
 
Post-traumatic peritonitis
❑ After blunt abdominal trauma
❑ After penetrating abdominal trauma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Differential diagnosis

Classification of acute abdomen based on etiology Presentation Symptoms Signs Diagnosis Comments
Fever Abdominal Pain Jaundice Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Common causes of Peritonitis Primary Peritonitis Spontateous Bacterial Peritonitis + Diffuse - - - Hypoactive Ascitic fluid PMN

>250cells/mm³

Culture: Positive for single organism

Ultrasound for evaluation of liver cirrhosis
Secondary Peritonitis Perforated gastric and duodenal ulcer + Diffuse - + + N Glucose

< 50mg/dl

Ascitic fluid LDH > serum LDH

Total Protein

> 1g/dl

Air under diaphragm in upright CXR Upper GI endoscopy for diagnosis
Acute Cholangitis + RUQ + - - N Abnormal LFT Ultrasound shows billiary dilatation Billiray drainage (ERCP) + IV antibiotics
Acute Cholecystitis + RUQ + - - Hypoactive
  • Hyperbilirubinemia
  • Leukocytosis
Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute Pancreatitis + Epigaster +/- - - N Increased Amylase / Lipase Ultrasound shows evidence of inflammation Pain radiation to back
Acute Appendicitis + RLQ - + + Hypoactive Leukocytosis Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Acute Diverticulitis + LLQ +/- + - Hypoactive Leukocytosis CT scan and ultrasound shows evidence of inflammation
Acute Salpingitis + LLQ/ RLQ - +/- +/- N Leukocytosis Pelvic ultrasound Vaginal discharge
Hollow Viscous Obstruction Small Intestine obstruction - Diffuse - + +/- Hyperactive then absent Leukocytosis Abdominal X ray Nausea & vomiting associated with constipation, abdominal distention.
Volvulus - Diffuse - + - Hypoactive Leukocytosis CT scan and abdominal X ray Nausea & vomiting associated with constipation, abdominal distention.
Biliary Colic - RUQ + - - N Increased bilirubin and alkaline phosphatase Ultrasound Nausea & vomiting
Renal Colic - Flank Pain - - - N Hematuria CT scan and ultrasound Colicky abdominal pain associated with nausea & vomiting
Vascular Disorders Ischemic causes Mesenteric Ischemia +/- Periumbilical - - - Hyperactive Leukocytosis and lactic acidosis CT scan Nausea & vomiting, normal physical examination
Acute Ischemic Colitis
Hemorrhagic causes Ruptured Abdominal Aortic Aneurysm Diffuse
Intraabdominal or Retroperitoneal Hemorrhage Diffuse
Gynaecological Causes Ovarian Cyst Complications Torsion of the Cyst RLQ / LLQ
Cyst Rupture RLQ / LLQ
Pregnancy Ruptured Ectopic Pregnancy RLQ / LLQ Positive Urine beta HCG

References

  1. Wittmann DH, Schein M, Condon RE (1996). "Management of secondary peritonitis". Ann Surg. 224 (1): 10–8. PMC 1235241. PMID 8678610.
  2. Nathens AB, Rotstein OD, Marshall JC (1998) Tertiary peritonitis: clinical features of a complex nosocomial infection. World J Surg 22 (2):158-63. PMID: 9451931
  3. Mishra SP, Tiwary SK, Mishra M, Gupta SK (2014) An introduction of Tertiary Peritonitis. J Emerg Trauma Shock 7 (2):121-3. DOI:10.4103/0974-2700.130883 PMID: 24812458