Peritonitis – Causes, Symptoms & Treatment
Peritonitis is a serious inflammation of the peritoneum lining the abdominal cavity. It is a medical emergency requiring immediate treatment.
Things worth knowing about "Peritonitis"
Peritonitis is a serious inflammation of the peritoneum lining the abdominal cavity. It is a medical emergency requiring immediate treatment.
What is Peritonitis?
Peritonitis is an inflammation of the peritoneum, the thin tissue layer that lines the inner wall of the abdomen and covers most of the abdominal organs. It is a life-threatening medical emergency that requires immediate medical attention. Without prompt treatment, peritonitis can lead to severe complications including sepsis (blood poisoning) and multiple organ failure.
Causes
Peritonitis is classified as either primary or secondary:
Primary Peritonitis
Primary peritonitis occurs without a direct injury or perforation of an organ. It is typically caused by bacteria entering the peritoneum through the bloodstream. This form is most common in patients with liver cirrhosis or kidney disease.
Secondary Peritonitis
Secondary peritonitis is far more common and results from a rupture or perforation of an abdominal organ. Common causes include:
- Perforation of a stomach or duodenal ulcer
- Ruptured appendix (perforated appendicitis)
- Bowel perforation due to diverticulitis
- Abdominal trauma from an accident or surgery
- Complications following abdominal surgery
- Inflammatory bowel diseases such as Crohn's disease
Symptoms
Symptoms of peritonitis typically appear suddenly and are severe. The most common signs include:
- Sudden, severe abdominal pain that worsens with movement
- Rigid, board-like abdomen due to involuntary muscle tension
- Nausea and vomiting
- High fever and chills
- Abdominal bloating and tenderness
- Absent or reduced bowel sounds (paralytic ileus)
- Circulatory instability, potentially leading to septic shock
Diagnosis
Diagnosis is based on a combination of methods:
- Physical examination: The doctor palpates the abdomen and checks for typical signs such as rebound tenderness (Blumberg sign).
- Blood tests: Elevated inflammatory markers (CRP, white blood cell count) indicate infection and inflammation.
- Imaging: X-rays, ultrasound, or computed tomography (CT) of the abdomen help identify the source of the problem.
- Paracentesis: In some cases, fluid is aspirated from the abdominal cavity and analysed.
Treatment
Treatment of peritonitis must begin immediately and typically requires hospitalization. The key treatment steps are:
Surgical Treatment
In most cases, emergency surgery is necessary to correct the underlying cause (e.g., closing a perforated organ, removing an inflamed appendix) and to thoroughly clean the abdominal cavity.
Antibiotic Therapy
High-dose intravenous antibiotics are administered to combat the bacterial infection.
Intensive Care
Severely ill patients are monitored in the intensive care unit and receive supportive therapies such as intravenous fluids for circulatory stabilisation and, if necessary, mechanical ventilation.
Prognosis
The prognosis of peritonitis depends largely on how quickly treatment is initiated. When treated early, recovery is generally possible. However, if diagnosis is delayed or treatment is not given promptly, the mortality rate increases significantly.
References
- Wittmann, D. H.: Peritonitis – Pathophysiology and Treatment. Springer Verlag, Berlin.
- Sartelli, M. et al.: 2013 WSES guidelines for management of intra-abdominal infections. World Journal of Emergency Surgery, 8(1):3, 2013.
- World Health Organization (WHO): Guidelines for Essential Trauma Care. WHO Press, Geneva. Available at: https://www.who.int
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