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* Tertiary peritonitis is defined as the persistant or recurrent intra-abdominal infection that occur in ≥48 hours following the successful and adequate surgical source control of primary or secondary peritonitis.<ref name="pmid16003060">Calandra T, Cohen J, International Sepsis Forum Definition of Infection in the ICU Consensus Conference (2005) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16003060 The international sepsis forum consensus conference on definitions of infection in the intensive care unit.] ''Crit Care Med'' 33 (7):1538-48. PMID: [https://pubmed.gov/16003060 16003060]</ref><ref name="pmid12593701">Evans HL, Raymond DP, Pelletier SJ, Crabtree TD, Pruett TL, Sawyer RG (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12593701 Tertiary peritonitis (recurrent diffuse or localized disease) is not an independent predictor of mortality in surgical patients with intraabdominal infection.] ''Surg Infect (Larchmt)'' 2 (4):255-63; discussion 264-5. [http://dx.doi.org/10.1089/10962960152813296 DOI:10.1089/10962960152813296] PMID: [https://pubmed.gov/12593701 12593701]</ref><ref name="pmid9451931">Nathens AB, Rotstein OD, Marshall JC (1998) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9451931 Tertiary peritonitis: clinical features of a complex nosocomial infection.] ''World J Surg'' 22 (2):158-63. PMID: [https://pubmed.gov/9451931 9451931]</ref>
* Tertiary peritonitis is defined as the persistant or recurrent intra-abdominal infection that occur in ≥48 hours following the successful and adequate surgical source control of primary or secondary peritonitis.<ref name="pmid16003060">Calandra T, Cohen J, International Sepsis Forum Definition of Infection in the ICU Consensus Conference (2005) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16003060 The international sepsis forum consensus conference on definitions of infection in the intensive care unit.] ''Crit Care Med'' 33 (7):1538-48. PMID: [https://pubmed.gov/16003060 16003060]</ref><ref name="pmid12593701">Evans HL, Raymond DP, Pelletier SJ, Crabtree TD, Pruett TL, Sawyer RG (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12593701 Tertiary peritonitis (recurrent diffuse or localized disease) is not an independent predictor of mortality in surgical patients with intraabdominal infection.] ''Surg Infect (Larchmt)'' 2 (4):255-63; discussion 264-5. [http://dx.doi.org/10.1089/10962960152813296 DOI:10.1089/10962960152813296] PMID: [https://pubmed.gov/12593701 12593701]</ref><ref name="pmid9451931">Nathens AB, Rotstein OD, Marshall JC (1998) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9451931 Tertiary peritonitis: clinical features of a complex nosocomial infection.] ''World J Surg'' 22 (2):158-63. PMID: [https://pubmed.gov/9451931 9451931]</ref>
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Peritonitis may be classified according to the etiology into 3 subtypes: primary, secondary, and tertiary peritonitis.
=== Classification Based on Etiology ===
Peritonitis is classified based on the cause of the inflammatory process and the character of microbial contamination as follows:<ref name="pmid8678610">{{cite journal| author=Wittmann DH, Schein M, Condon RE| title=Management of secondary peritonitis. | journal=Ann Surg | year= 1996 | volume= 224 | issue= 1 | pages= 10-8 | pmid=8678610 | doi= | pmc=1235241 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8678610  }} </ref><ref name="pmid9451931">Nathens AB, Rotstein OD, Marshall JC (1998) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9451931 Tertiary peritonitis: clinical features of a complex nosocomial infection.] ''World J Surg'' 22 (2):158-63. PMID: [https://pubmed.gov/9451931 9451931]</ref><ref name="pmid24812458">Mishra SP, Tiwary SK, Mishra M, Gupta SK (2014) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=24812458 An introduction of Tertiary Peritonitis.] ''J Emerg Trauma Shock'' 7 (2):121-3. [http://dx.doi.org/10.4103/0974-2700.130883 DOI:10.4103/0974-2700.130883] PMID: [https://pubmed.gov/24812458 24812458]</ref>
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{{familytree | | | | | | | | | A01 | | | | | |A01=Peritonitis}}
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{{familytree | | C01 | | | | | C02 | | | | | C03 |C01='''Primary peritonitis'''|C02='''Secondary peritonitis'''|C03='''Tertiary peritonitis'''}}
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{{familytree |boxstyle=text-align: left; | | B01 | | | | | |!| | | | | | B02 |B01= ❑ Spontaneous peritonitis<br>❑ Peritonitis in patients with CAPD<br>❑ Tuberculous peritonitis |B02= ❑ Peritonitis without evidence for pathogens<br>❑ Peritonitis with fungi<br>❑ Peritonitis with low-grade pathogenic bacteria}}
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{{familytree |boxstyle=text-align: left; | | | | D02 | | | D03 | | | D04 | | |D02='''Acute perforation peritonitis'''<br>❑ Gastrointestinal perforation<br>❑ Intestinal ischemia<br>❑ Pelviperitonitis and other forms|D03='''Postoperative peritonitis'''<br>❑ Anastomotic leak<br>❑ Accidental perforation and devascularization|D04='''Post-traumatic peritonitis'''<br>❑ After blunt abdominal trauma<br>❑ After penetrating abdominal trauma}}
{{familytree | | | | | | | | | | | | | | | | | | | }}
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Revision as of 20:13, 7 February 2017

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:  ; Shivani Chaparala M.B.B.S [2]

Synonyms and keywords: Acute bacterial peritonitis, acute generalized peritonitis, acute peritonitis, abscess of suppurative peritonitis, acute suppurative peritonitis, purulent peritonitis, subphrenic peritonitis, pelvic peritonitis, acute serositis, aseptic peritonitis, chronic peritonitis, continuous ambulatory peritoneal dialysis associated peritonitis, fungal peritonitis, granulomatous peritonitis, peritoneal dialysis-associated peritonitis, serositis, chemical peritonitis, neonatal peritonitis, tuberculous peritonitis, peritoneal abscess, spontaneous bacterial peritonitis, benign paroxysmal peritonitis, pyogranulomatous serositis, perforation peritonitis, CAPD peritonitis, primary peritonitis, secondary peritonitis, tertiary peritonitis.

For more information related to Primary peritonitis click here
For more information related to Secondary peritonitis click here

Overview

Peritonitis defined as inflammation of peritoneum (a serosal membrane lining the abdominal cavity and abdominal viscera) is associated with a higher mortality rate secondary to bacteremia and sepsis syndrome. Most common cause of peritonitis in approximately 80% adults is perforation of the gastrointestinal or biliary tract. Other less common causes include liver cirrhosis (result of alcoholism), and peritoneal dialysis associated peritonitis. Peritonitis can also result from injury and contamination with microorganisms, chemicals or both. It may be localized or generalized, and can have an acute course in infection secondary to rupture of a hollow viscus or follows a chronic course as seen in tuberculous peritonitis. Patients present with severe abdominal pain associated with fever, chills, nausea and vomiting. Peritonitis is a emergency medical/surgical condition requiring prompt medical attention and treatment.

Definition

Peritonitis is defined as inflammation of the peritoneum (a tissue that lines the inner wall of the abdominal cavity and covers most of the abdominal organs) from any cause. In contrast to peritonitis intrabdominal infection is defined as inflammation of peritoneum due to an infectious cause.[1]

Primary or Spontaneous Peritonitis Secondary Peritonitis Tertiary Peritonitis
  • Primary peritonitis/ spontaneous bacterial peritonitis (SBP) represents a group of diseases with different causes characterized by ascitic fluid infection of the peritoneal cavity without an evident surgically treatable intra-abdominal source of infection. It is usually associated with cirrhosis and ascites in adults.[2] Primary peritonitis lacks an identifiable anatomical derangement.[3]
  • Secondary peritonitis is defined as the infection of the peritoneum due to spillage of organisms into the peritoneal cavity resulting from hollow viscus perforation, anastomotic leak, ischemic necrosis, or other injuries of the gastrointestinal tract.[4]
  • Tertiary peritonitis is defined as the persistant or recurrent intra-abdominal infection that occur in ≥48 hours following the successful and adequate surgical source control of primary or secondary peritonitis.[4][5][6]

Peritonitis may be classified according to the etiology into 3 subtypes: primary, secondary, and tertiary peritonitis.

Classification Based on Etiology

Peritonitis is classified based on the cause of the inflammatory process and the character of microbial contamination as follows:[1][6][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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  1. ↑ 1.0 1.1 Wittmann DH, Schein M, Condon RE (1996) Management of secondary peritonitis. Ann Surg 224 (1):10-8. PMID: 8678610
  2. ↑ Wiest R, Krag A, Gerbes A (2012) Spontaneous bacterial peritonitis: recent guidelines and beyond. Gut 61 (2):297-310. DOI:10.1136/gutjnl-2011-300779 PMID: 22147550
  3. ↑ 3.0 3.1 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
  4. ↑ 4.0 4.1 Calandra T, Cohen J, International Sepsis Forum Definition of Infection in the ICU Consensus Conference (2005) The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med 33 (7):1538-48. PMID: 16003060
  5. ↑ Evans HL, Raymond DP, Pelletier SJ, Crabtree TD, Pruett TL, Sawyer RG (2001) Tertiary peritonitis (recurrent diffuse or localized disease) is not an independent predictor of mortality in surgical patients with intraabdominal infection. Surg Infect (Larchmt) 2 (4):255-63; discussion 264-5. DOI:10.1089/10962960152813296 PMID: 12593701
  6. ↑ 6.0 6.1 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
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