Definition
- Peritonitis: Inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.
Etiology
- 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.
- Types:
- 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.
Clinical Presentation
- 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.
Investigations
- 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.
Management
- Immediate hospitalisation.
- Administer broad-spectrum intravenous antibiotics ā 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.
Complications
- 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.
Early recognition and intervention in peritonitis are crucial given its potential severity and life-threatening complications.
