Peritonitis

Inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.

• Most commonly due to a bacterial infection often secondary to abdominal trauma, surgeries, or a ruptured organ.
• Other causes: Chemical irritants (e.g., bile, gastric acid), blood, fungi, or viruses.

• Primary: Often due to cirrhosis or ascites, not caused by any identifiable intra-abdominal source.
• Secondary: Resulting from a pathological condition within the abdomen like appendicitis or diverticulitis.
• Tertiary: Persistent infection after treatment of primary or secondary peritonitis.

• Severe abdominal pain that is worsened with movement.
• Abdominal tenderness and rigidity (“board-like abdomen“).
• Fever and chills.
• Nausea and vomiting.
• Anorexia.
• Possible altered bowel habits.

• Abdominal X-ray: May show gas patterns suggestive of ileus or free air if there’s a perforation.
• Abdominal CT scan: Useful to determine the cause, especially in secondary peritonitis.
• Paracentesis: Aspirating fluid from the abdomen for examination, cultures, and cell counts.
• Complete blood count: May show elevated white blood cells.
• Blood cultures: To identify any causative bacteria.

• Immediate hospitalisation.
• Administer broad-spectrum intravenous antibiotics – later tailored based on culture results.
• Surgery to treat the root cause, e.g., repair of a ruptured organ.
• Fluid resuscitation and possible nutritional support.
• Analgesics for pain.

• Septic shock: Life-threatening decrease in blood pressure due to sepsis.
• Abscess formation in the abdomen.
• Organ failure.
• Adhesions leading to bowel obstruction in the long term.

• Peritonitis occurs due to the inflammation of the peritoneum, most commonly due to a bacterial infection.
• Early recognition and intervention in peritonitis are crucial given its potential severity and life-threatening complications.
• Commonly the patient presents with severe abdominal pain and rigidity (“board-like abdomen“).
• Diagnosis is confirmed through imaging, paracentesis and blood cultures.
• Management includes immediate hospitalisation, supportive care, broad-spectrum intravenous antibiotics and surgery to treat the underlying cause.