Peritonitis: Causes, Symptoms & Treatment
Peritonitis is a serious inflammation of the peritoneum, usually caused by bacterial infection, requiring immediate medical treatment.
Things worth knowing about "Peritonitis"
Peritonitis is a serious inflammation of the peritoneum, usually caused by bacterial infection, requiring immediate medical treatment.
What is Peritonitis?
Peritonitis is an acute or chronic inflammation of the peritoneum, the thin tissue layer that lines the abdominal cavity and covers most of the abdominal organs. It is a medical emergency that can become life-threatening without prompt treatment. Peritonitis is classified as primary (spontaneous) or secondary, with secondary peritonitis being by far the more common form.
Causes
The most common cause of peritonitis is a bacterial infection, which can arise from various conditions:
- Appendicitis with perforation of the appendix
- Perforation of a stomach or duodenal ulcer
- Bowel injury due to trauma or surgery
- Diverticulitis with intestinal perforation
- Bowel obstruction (ileus) leading to intestinal wall necrosis
- Severe inflammatory bowel disease such as Crohn's disease
- Spontaneous bacterial peritonitis in patients with liver cirrhosis and ascites
Less commonly, peritonitis can be caused by fungal infections or chemical irritants such as bile or stomach acid leaking into the abdominal cavity.
Symptoms
Peritonitis typically presents with sudden, severe abdominal pain. Other common symptoms include:
- Rigid abdomen (involuntary muscle guarding)
- Severe tenderness on palpation
- Fever and chills
- Nausea and vomiting
- Abdominal bloating (distension)
- Absent bowel sounds (paralytic ileus)
- Circulatory failure and sepsis in severe cases
Diagnosis
Diagnosis is based on clinical examination, laboratory tests, and imaging studies:
- Physical examination: Rebound tenderness (Blumberg sign), abdominal rigidity
- Blood tests: Elevated inflammatory markers (CRP, white blood cell count, procalcitonin)
- Ultrasound: Detection of free fluid in the abdominal cavity
- Computed tomography (CT) of the abdomen: Detailed assessment of the cause and extent of inflammation
- X-ray: Free air under the diaphragm in cases of perforation
Treatment
Peritonitis is a surgical emergency requiring immediate hospital treatment:
Surgical Treatment
In most cases, emergency surgery is necessary to eliminate the source of infection (e.g., appendectomy, closure of a perforation) and to wash out the abdominal cavity (peritoneal lavage).
Medical Treatment
- Intravenous antibiotics to combat bacterial infection
- Pain management and intravenous fluids to stabilize circulation
- Intensive care monitoring in severe cases
Prognosis
With rapid diagnosis and treatment, the outlook is generally favorable. If left untreated or if treatment is delayed, peritonitis can progress to a life-threatening septic shock.
References
- Sartelli, M. et al. - WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World Journal of Emergency Surgery, 2017.
- Wittmann, D.H. et al. - Management of secondary peritonitis. Annals of Surgery, 1996.
- Leppaniemi, A. et al. - 2019 WSES guidelines for the management of severe acute pancreatitis. World Journal of Emergency Surgery, 2019.
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