Secondary peritonitis causes: Difference between revisions

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Latest revision as of 00:07, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]

Overview

Secondary peritonitis has numerous causes. It most often results from entry of enteric bacteria into the peritoneal cavity through a necrotic defect in th wall of the intestines or other viscus as a result of obstruction, infarction or after rupture of an intra-abdominal visceral abscess. It most often occurs after perforation of appendix. Nonbacterial causes of peritonitis include leakage of blood into the peritoneal cavity due to rupture of a tubal pregnancy, ovarian cyst, or aneurysmal vessel.

Causes

Life-Threatening Causes

Common causes

Common causes of secondary peritonitis include:^[1]^[2]

Causes by Source

Infected Secondary Peritonitis		Non-infected Secondary Peritonitis
Perforation of a hollow viscus organ	Disruption of the peritoneum	Leakage of sterile body fluids into the peritoneum	Sterile abdominal surgery	Rarer non-infectious causes
Perforation of a hollow viscus (most common cause of peritonitis) Perforation of the distal esophagus (Boerhaave syndrome) Perforation of the stomach (peptic ulcer, Gastric carcinoma) Perforation of the duodenum (peptic ulcer) Perforations of the remaining intestine (e.g. Appendicitis, Diverticulitis, Meckel diverticulum, IBD, Intestinal infarction, Intestinal strangulation, Colorectal carcinoma, Meconium peritonitis) Perforation of the gallbladder (cholecystitis) Other possible causes for perforation Trauma Ingestion of a sharp foreign body (such as a fish bone) Perforation by an endoscope or catheter Most common organisms: mixed bacteria Gram-negative bacilli (e.g. Escherichia coli), Anaerobic bacteria (e.g. Bacteroides fragilis)	Trauma Surgical wound Peritoneal dialysis Chemotherapy Most common organisms Mixed bacteria Staphylococcus aureus Coagulase-negative staphylococci Fungi such as Candida	Sterile body fluids such as Blood(e.g.Endometriosis, Blunt abdominal trauma), Gastric juice (e.g.Peptic ulcer, Gastric carcinoma), Bile (e.g. Liver biopsy), Urine (e.g. Pelvic trauma), Menstruum (e.g. salpingitis), Pancreatic juice (pancreatitis), These body fluids are sterile at first, they frequently become infected once they leak out of their organ, leading to infectious peritonitis within 24-48h.	Due to sterile foreign body inadvertently left in the abdomen after surgery (e.g. gauze, sponge)	Familial Mediterranean fever Porphyria Systemic lupus erythematosus

Causes by Organ System

Cause of Peforation	Most likely organism
Nonperforation secondary peritonitis
Acute appendicitis	β-Hemolytic Streptococcus Klebsiella pneumoniae Clostridium perfringens Enterococcus
Loculated perforation of gastric ulcer	Escherichia coli Group D Streptococcus Bacillus species
Post operative gastric ulcer perforation	Staphylococcus epidermidis Propionibacterium species Fungi
Loculated perforation of umbilical hernia	Staphylococcus aureus
Colonic ulcer	Enterobacter cloacae Clostridium species Enterococcus Bacteroides fragilis
Loculated perforation of colonic polypectomy	Escherichia coli α-Streptococcus Unidentified Gram-positive organism
Colonic ulcer	Escherichia coli
Infected pancreaticpseudocyst	Escherichia coli
Postoperative in general	Unidentified gram-negative coccobacillus Staphylococcus aureus
Perforation secondary peritonitis
Perforated gastric ulcer	Pseudomonas Enterococcus Candida
Perforated duodenal ulcer	Klebsiella pneumoniae Candida albicans
Perforated bowel	α-streptococcus Clostridium species Candida albicans
Perforated gallbladder	Escherichia coli Klebsiella pneumoniae

References

↑ Akriviadis EA, Runyon BA (1990). "Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis". Gastroenterology. 98 (1): 127–33. PMID 2293571.
↑ Wong PF, Gilliam AD, Kumar S, Shenfine J, O'Dair GN, Leaper DJ (2005). "Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults". Cochrane Database Syst Rev (2): CD004539. doi:10.1002/14651858.CD004539.pub2. PMID 15846719.

[pmid2293571-1] Akriviadis EA, Runyon BA (1990). "Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis". Gastroenterology. 98 (1): 127–33. PMID 2293571.

[pmid15846719-2] Wong PF, Gilliam AD, Kumar S, Shenfine J, O'Dair GN, Leaper DJ (2005). "Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults". Cochrane Database Syst Rev (2): CD004539. doi:10.1002/14651858.CD004539.pub2. PMID 15846719.

[1]

[2]

@@ Line 4: / Line 4: @@
 ==Overview==
-Secondary peritonitis has numerous causes. Nonbacterial causes of peritonitis include leakage of blood into the peritoneal cavity due to rupture of a tubal pregnancy, ovarian cyst, or aneurysmal vessel.
+Secondary peritonitis has numerous causes. It most often results from entry of [[Enterobacteria|enteric bacteria]] into the [[peritoneal cavity]] through a necrotic defect in th wall of the [[intestines]] or other viscus as a result of [[obstruction]], [[infarction]] or after rupture of an [[Abscess|intra-abdominal visceral abscess]]. It most often occurs after [[perforation]] of [[appendix]]. Nonbacterial causes of [[peritonitis]] include leakage of blood into the [[peritoneal cavity]] due to rupture of a [[tubal pregnancy]], [[ovarian cyst]], or [[Aneurysm|aneurysmal vessel]].
 ==Causes==
 ===Life-Threatening Causes===
+* Solid organ rupture
+* [[Perforated peptic ulcer]]
+* [[Abscess|Tubo-ovarian abscess]]
+* [[Bowel perforation|Small bowel perforation]]
 ===Common causes===
-* Some of the more common causes of secondary peritonitis include:
+Common causes of secondary peritonitis include:<ref name="pmid2293571">{{cite journal| author=Akriviadis EA, Runyon BA| title=Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. | journal=Gastroenterology | year= 1990 | volume= 98 | issue= 1 | pages= 127-33 | pmid=2293571 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2293571  }} </ref><ref name="pmid15846719">{{cite journal| author=Wong PF, Gilliam AD, Kumar S, Shenfine J, O'Dair GN, Leaper DJ| title=Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults. | journal=Cochrane Database Syst Rev | year= 2005 | volume=  | issue= 2 | pages= CD004539 | pmid=15846719 | doi=10.1002/14651858.CD004539.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15846719  }} </ref>
-** Perforated PUD,
+* [[Perforated peptic ulcer|Perforated PUD]]
-** Appendicitis,
+* [[Appendicitis]]
-** Diverticulitis,
+* [[Diverticulitis]]
-** Acute cholecystitis,
+* [[Acute cholecystitis]]
-** Pancreatitis, and
+* [[Pancreatitis]]
-** Postsurgical complications.
+* Post-surgical complications
+===Causes by Source===
+{| class="wikitable"
+! colspan="2" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|  Infected Secondary Peritonitis}}
+! colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| Non-infected Secondary Peritonitis}}
+|-
+! style="width: 35%;" | Perforation of a hollow viscus organ
+! style="width: 20%;" |Disruption of the [[peritoneum]]
+!Leakage of sterile body fluids into the [[peritoneum]]
+!Sterile [[abdominal surgery]]
+!Rarer non-infectious causes
+|-
+| valign="top" | '''''[[Bowel perforation|Perforation of a hollow viscus]]''''' (most common cause of [[peritonitis]])
+* Perforation of the [[Esophagus|distal esophagus]] ([[Boerhaave syndrome]])
+* Perforation of the [[stomach]] ([[peptic ulcer]], [[Gastric carcinoma]])
+* Perforation of the [[duodenum]] ([[peptic ulcer]])
+* Perforations of the remaining [[intestine]] (e.g. [[Appendicitis]], [[Diverticulitis]], [[Meckel diverticulum]], [[IBD]], [[Intestinal infarction]], [[Intestinal strangulation]], [[Colorectal carcinoma]], [[Meconium peritonitis]])
+*Perforation of the [[gallbladder]] ([[cholecystitis]])
+'''Other possible causes for perforation'''
+* [[Trauma]]
+* Ingestion of a sharp [[foreign body]] (such as a fish bone)
+* Perforation by an [[endoscope]] or [[catheter]]
+''' Most common organisms:''' mixed [[bacteria]]
+*[[Gram-negative bacilli]] (e.g. [[Escherichia coli]]), [[Anaerobic bacteria]] (e.g. [[Bacteroides fragilis]])
+| valign="top" |
+* [[Trauma]]
+* [[Surgical wound]]
+* [[Peritoneal dialysis]]
+* [[Chemotherapy]]
+''' Most common organisms'''
+* Mixed [[bacteria]]
+* [[Staphylococcus aureus]]
+* [[Coagulase-negative staphylococci]]
+* [[Fungi]] such as [[Candida]]
+|valign=top|
+'''''Sterile body fluids''''' such as
+* [[Blood]](e.g.[[Endometriosis]], Blunt abdominal trauma),
+* [[Gastric juice]] (e.g.[[Peptic ulcer]], [[Gastric carcinoma]]),
+* [[Bile]] (e.g. [[Liver biopsy]]),
+* [[Urine]] (e.g. [[Pelvic trauma]]),
+* [[Menstruum]] (e.g. [[salpingitis]]),
+* [[Pancreatic juice]] ([[pancreatitis]]),
+These body fluids are sterile at first, they frequently become infected once they leak out of their organ, leading to infectious peritonitis within 24-48h.
+|valign=top|
+Due to [[sterile]] [[foreign body]] inadvertently left in the abdomen after surgery (e.g. [[gauze]], [[sponge]])
+|valign=top|
+* [[Familial Mediterranean fever]]
+* [[Porphyria]]
+* [[Systemic lupus erythematosus]]
+|}
 ===Causes by Organ System===
 {| border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" width="75%"
@@ Line 20: / Line 78: @@
 !colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Most likely organism'''}}
 |-
-! colspan="2" |Nonperforation secondary peritonitis
+!colspan="2" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Nonperforation secondary peritonitis'''}}
 |-
-!Acute appendicitis
+![[Acute appendicitis]]
 |
-* β-Hemolytic Streptococcus
+* [[Streptococcus|β-Hemolytic Streptococcus]]
-* Klebsiella pneumoniae
+* [[Klebsiella pneumoniae]]
-* Clostridium perfringens
+* [[Clostridium perfringens]]
-* Enterococcus
+* [[Enterococcus]]
 |-
-!Loculated perforation of
+![[Perforated peptic ulcer|Loculated perforation of]]
-gastric ulcer
+[[Perforated peptic ulcer|gastric ulcer]]
 |
-* Escherichia coli
+* [[Escherichia coli]]
-* Group D Streptococcus
+* [[Streptococcus|Group D Streptococcus]]
-* Bacillus species
+* [[Bacillus]] species
 |-
 !Post operative
 gastric ulcer perforation
 |
-* Staphylococcus epidermidis
+* [[Staphylococcus epidermidis]]
-* Proprianobacterium species
+* [[Propionibacterium]] species
-* Fungi
+* [[Fungi]]
 |-
 !Loculated perforation of
 umbilical hernia
 |
-* Staphylococcus aureus
+* [[Staphylococcus aureus]]
 |-
 !Colonic ulcer
 |
-* Enterobacter cloacae
+* [[Enterobacter cloacae]]
-* Clostridium species
+* [[Clostridium]] species
-* Enterococcus
+* [[Enterococcus]]
-* Bacteroides fragilis
+* [[Bacteroides fragilis]]
 |-
 !Loculated perforation of
 colonic polypectomy
 |
-* Escherichia coli
+* [[Escherichia coli]]
-* α-Streptococcus
+* [[Streptococcus|α-Streptococcus]]
-* Unidentified Gram-positive organism
+* [[Gram-positive bacteria|Unidentified Gram-positive organism]]
 |-
 !Colonic ulcer
 |
-* Escherichia coli
+* [[Escherichia coli]]
 |-
 !Infected
 pancreaticpseudocyst
 |
-* Escherichia coli
+* [[Escherichia coli]]
 |-
 !Postoperative
 in general
 |
-* Unidentified gram-negative coccobacillus
+* Unidentified [[Gram negative|gram-negative coccobacillus]]
-* Staphylococcus aureus
+* [[Staphylococcus aureus]]
 |-
-! colspan="2" |Perforation secondary peritonitis
+! colspan="2" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Perforation secondary peritonitis'''}}
 |-
 !Perforated gastric ulcer
 |
-* Pseudomonas
+* [[Pseudomonas]]
-* Enterococcus
+* [[Enterococcus]]
-* Candida
+* [[Candida]]
 |-
 !Perforated duodenal ulcer
 |
-* Klebsiella pneumoniae
+* [[Klebsiella pneumoniae]]
-* Candida albicans
+* [[Candida albicans]]
 |-
 !Perforated bowel
 |
-* α-streptococcus
+* [[Streptococcus|α-streptococcus]]
-* Clostridium species
+* [[Clostridium]] species
-* Candida albicans
+* [[Candida albicans]]
 |-
 !Perforated gallbladder
 |
-* Escherichia coli
+* [[Escherichia coli]]
-* Klebsielia pneumoniae
+* [[Klebsiella pneumoniae]]
 |}
 ==References==
+{{Reflist|2}}
+[[Category:Emergency mdicine]]
+[[Category:Disease]]
+[[Category:Up-To-Date]]
+[[Category:Infectious disease]]
+[[Category:Gastroenterology]]
+[[Category:Surgery]]