Peritonitis: Understanding Inflammation and Infection in the Abdomen

Written by Medicover Team and Medically Reviewed by Dr Sai Ram Ankam , Gastroenterologists Surgical

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Peritonitis is inflammation of the peritoneum, the thin tissue lining the inside of the abdomen and covering many abdominal organs. It is a serious condition that is most often caused by a bacterial or fungal infection, leakage of gastrointestinal contents, or irritation from substances such as stomach acid or bile.

Peritonitis can develop suddenly and may become life-threatening if the infection spreads into the bloodstream. Prompt medical evaluation and treatment are essential, particularly when severe abdominal pain, fever, vomiting, or abdominal swelling develops.

What Are the Types of Peritonitis?

Peritonitis can be classified according to how the inflammation develops and whether an identifiable source of infection is present. The main types include spontaneous, secondary, and tertiary peritonitis.

Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis (SBP) occurs when bacteria infect fluid that has accumulated in the abdominal cavity, usually without an obvious perforation or other source of infection. It most commonly occurs in people with advanced liver disease and ascites.

Secondary Peritonitis

Secondary peritonitis occurs when bacteria or gastrointestinal contents enter the peritoneal cavity because of an underlying problem such as a perforated bowel, ruptured appendix, perforated ulcer, or abdominal injury. It is a common surgical emergency and often requires antibiotics and treatment of the underlying source.

Tertiary Peritonitis

Tertiary peritonitis is a persistent or recurrent infection of the peritoneal cavity that occurs after treatment for secondary peritonitis, particularly in people who are seriously ill or have weakened immune defenses.

Localized and Generalized Peritonitis

Peritonitis may also be described as localized when inflammation is confined to a specific area of the abdomen, or generalized when it affects a larger portion of the peritoneal cavity.

What Are the Symptoms of Peritonitis?

Peritonitis symptoms can develop suddenly or progress over time depending on the underlying cause. Abdominal pain and tenderness are among the most characteristic symptoms. The abdomen may become swollen, and movement or touching the abdomen may make the pain worse.

Common symptoms include:

Severe abdominal pain: Pain may be persistent, worsen with movement, and become increasingly intense.
Abdominal tenderness: The abdomen may be extremely sensitive when touched or examined.
Abdominal swelling: Inflammation or fluid accumulation can cause abdominal distension.
Fever and chills: These may occur when an infection is responsible for peritonitis.
Nausea and vomiting: Digestive disturbances are common with significant abdominal inflammation.
Loss of appetite: Abdominal pain and illness can make eating difficult.
Constipation or diarrhea: Changes in bowel function may occur depending on the underlying cause.
Fatigue and weakness: Significant infection can cause marked tiredness and reduced energy.
Reduced urine output: Severe infection and dehydration can affect kidney function.

Severe peritonitis can progress to sepsis or septic shock. Warning signs may include confusion, rapid breathing, rapid heartbeat, dizziness, very low blood pressure, or extreme weakness and require emergency medical attention.

What Causes Peritonitis?

Peritonitis can develop when microorganisms enter the peritoneal cavity or when irritating substances cause inflammation of the peritoneum. The cause determines the type of peritonitis and influences the treatment required.

Infection

Bacterial or, less commonly, fungal infections can cause peritonitis. In spontaneous bacterial peritonitis, microorganisms infect accumulated abdominal fluid, particularly in people with advanced liver disease and ascites.

Gastrointestinal Perforation

A hole or rupture in the stomach or intestine can allow bacteria, digestive contents, or stool to enter the abdominal cavity. Conditions such as perforated peptic ulcers, ruptured appendicitis, diverticulitis, and bowel perforation can cause secondary peritonitis.

Abdominal Injury or Surgery

Trauma that penetrates the abdomen can introduce bacteria or cause damage to abdominal organs. Peritonitis can also develop as a complication of abdominal surgery, particularly when infection, leakage, or an injury to the gastrointestinal tract occurs.

Peritoneal Dialysis

People undergoing peritoneal dialysis can develop peritonitis if microorganisms enter the abdominal cavity through the dialysis catheter or during exchanges. Careful catheter and hand hygiene can reduce this risk.

Chemical Irritation

Peritoneal inflammation may occur when sterile substances such as stomach acid, bile, pancreatic enzymes, or intestinal contents leak into the abdominal cavity. This can cause chemical irritation and may subsequently become infected.

Other Underlying Conditions

Certain conditions can increase the risk of peritonitis, including advanced liver disease with ascites, inflammatory bowel disease, bowel obstruction, and conditions that increase the likelihood of gastrointestinal perforation.

When Should You See a Doctor for Peritonitis?

Peritonitis can become life-threatening quickly and should be evaluated urgently. Seek a gastroenterologist or immediate medical attention if you develop severe or worsening abdominal symptoms, particularly when they occur with fever or vomiting.

Severe or persistent abdominal pain
Marked abdominal tenderness or swelling
Fever or chills with abdominal pain
Persistent nausea or vomiting
Inability to eat, drink, pass stool, or pass gas
Severe weakness or worsening overall condition

Get emergency medical help immediately if:

Severe abdominal pain with a rigid or very swollen abdomen
Confusion, fainting, severe dizziness, or difficulty staying awake
Rapid breathing or a very fast heartbeat
Very low blood pressure or signs of shock
Persistent vomiting with signs of dehydration

Early treatment is important because untreated peritonitis can spread into the bloodstream and cause sepsis, septic shock, and organ failure.

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How Is Peritonitis Diagnosed?

Diagnosis begins with a medical history and physical examination. The healthcare provider assesses the location and severity of abdominal pain, tenderness, swelling, fever, and other signs of infection. Additional tests are used to identify the cause and determine how extensively the abdomen is affected.

Blood Tests

Blood tests may include a complete blood count and inflammatory markers to look for evidence of infection or inflammation. Kidney and liver function tests can help assess the severity of illness and guide treatment.

Imaging Tests

Abdominal imaging can help identify the source of peritonitis, such as a perforated bowel, abscess, or other abnormality.

CT scan: A CT scan of the abdomen and pelvis can help detect perforation, abscesses, inflammation, abnormal fluid collections, or other causes of peritonitis.
Ultrasound: Ultrasound can identify abdominal fluid and may help evaluate certain abdominal organs and conditions.
Abdominal X-ray: In selected cases, X-rays can help detect free air in the abdomen, which may indicate gastrointestinal perforation.

Peritoneal Fluid Analysis

When ascites is present, a sample of abdominal fluid may be obtained through paracentesis. The fluid can be examined for white blood cells, microorganisms, protein, and other findings. Fluid culture is particularly important when spontaneous bacterial peritonitis is suspected.

Diagnostic Surgery

If the cause cannot be determined through non-invasive testing or a surgical emergency is suspected, laparoscopy or open surgery may be performed. Surgery can help identify the source of infection and allow treatment at the same time.

What Are the Treatment Options for Peritonitis?

Peritonitis treatment depends on its cause, severity, and the patient's overall health. Treatment usually requires urgent medical care and may involve antibiotics, intravenous fluids, treatment of the underlying source, and surgery.

Antibiotics

Antibiotics are commonly given when bacterial peritonitis is suspected or confirmed. Broad-spectrum antibiotics may be started initially to cover likely organisms and adjusted later according to culture results and the patient's clinical response.

Surgery

Surgery may be necessary for secondary peritonitis caused by a perforated appendix, stomach, intestine, or other abdominal organ. The procedure may involve repairing or removing the damaged section, controlling contamination, and treating an abscess or other source of infection.

Drainage of Abscesses or Infected Fluid

When an abscess or localized infected fluid collection is present, drainage may be performed using a catheter placed through the skin or through surgery, depending on the location and severity of the infection.

Intravenous Fluids and Supportive Care

Intravenous fluids help maintain circulation and correct dehydration. Patients with severe infection may require oxygen, nutritional support, pain management, and close monitoring of blood pressure, urine output, and organ function.

Treatment of Spontaneous Bacterial Peritonitis

SBP is treated with appropriate antibiotics and management of the underlying liver disease and ascites. Albumin may be administered in selected patients to reduce the risk of kidney complications.

Treatment of the Underlying Condition

Long-term management may include treating conditions that contributed to peritonitis, such as liver disease, inflammatory bowel disease, or complications related to peritoneal dialysis.

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What Are the Complications of Peritonitis?

Without prompt treatment, peritonitis can spread rapidly and cause serious complications. The risk depends on the underlying cause, the duration of infection, and the patient's overall health.

Sepsis: A severe response to infection that can cause widespread inflammation and organ dysfunction.
Septic shock: A life-threatening complication in which severe infection causes dangerously low blood pressure and inadequate blood flow to organs.
Multiple organ failure: Severe infection can impair the function of the kidneys, lungs, liver, heart, and other organs.
Intra-abdominal abscess: Pockets of infected fluid or pus may develop within the abdominal cavity.
Adhesions: Healing after abdominal inflammation can cause bands of scar tissue that may lead to bowel obstruction.
Bowel obstruction: Inflammation, adhesions, or underlying bowel disease can interfere with the normal movement of intestinal contents.
Death: Untreated or severe peritonitis can be fatal, particularly when it progresses to sepsis or septic shock.

How Can Peritonitis Be Prevented?

Not every case of peritonitis can be prevented, but reducing the risk of infections and promptly treating conditions that can cause abdominal perforation can help lower the risk.

Practice good hygiene: Wash hands regularly, particularly before handling a peritoneal dialysis catheter or supplies.
Follow peritoneal dialysis care instructions: Use proper sterile or clean techniques as instructed by the dialysis team and report catheter problems promptly.
Treat abdominal infections promptly: Seek medical attention for conditions such as appendicitis, diverticulitis, or severe abdominal infections.
Manage chronic conditions: Appropriate management of liver disease, inflammatory bowel disease, and other underlying conditions can reduce complications.
Follow postoperative instructions: After abdominal surgery, report increasing pain, fever, wound problems, vomiting, or abdominal swelling to the healthcare team.
Seek urgent care after abdominal injury: Significant abdominal trauma requires prompt medical assessment because internal organ damage may not be immediately obvious.

What Is the Outlook for Peritonitis?

The outlook for peritonitis depends largely on its cause, how quickly treatment begins, the extent of infection, and the person's overall health. When diagnosed and treated promptly, many cases can be successfully managed.

Severe or untreated peritonitis has a much higher risk of complications, particularly sepsis and organ failure. Early recognition of symptoms and urgent treatment are therefore essential for improving outcomes.