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. 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

• Solid organ rupture
• Perforated peptic ulcer
• Tubo-ovarian abscess
• Small bowel perforation

Common causes

Common causes of secondary peritonitis include:

• Perforated PUD
• Appendicitis
• Diverticulitis
• Acute cholecystitis
• Pancreatitis
• Post-surgical complications

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