Secondary peritonitis causes

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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. 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]

Perforated PUD
Appendicitis
Diverticulitis
Acute cholecystitis
Pancreatitis
Post-surgical complications

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 Proprianobacterium 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 Klebsielia pneumoniae

Causes of Infected Secondary Peritonitis

Perforation of a hollow viscus organ	Disruption of the peritoneum
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

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.

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