Peritonitis Information

Peritonitis occurs when the peritoneum, a thin membranous tissue that covers the walls of the stomach, intestines and other organs in the abdominal cavity, becomes inflamed. This inflammation is caused by a bacterial infection. Although the peritoneum's job is to reinforce the abdominal organs and guard against infection, there are instances when the peritoneum itself becomes infected. It is serious enough to be considered fatal and often requires an emergency surgical procedure.

As soon as infection sets in, the whole peritoneum becomes inflamed or pus-filled abscesses may form. When this happens, the muscles of the intestine walls become rigid and the digestive process is hampered as the contents of the intestines cease their forward movement.

People stricken with Peritonitis will most commonly experience a dull ache or sharp pain, including swelling and tenderness. This pain will either be localized in the region of the peritoneum, or generalized to include the whole abdomen. This ache or pain will be especially apparent whenever the afflicted person makes a movement involving the peritoneum, like when they cough or flex their hips. There will also be a manifestation of fever and chills, nausea and vomiting caused by paralysis of the intestines, and a rigid abdomen, also known as “washboard abdomen”.

Other symptoms of Peritonitis include fast but shallow breathing, increased heart rate, low blood pressure, excessive sweating, paleness, cold and clammy skin, very small amounts of urine, and difficulty in passing gas or defecation.

Peritonitis can either be primary or secondary. Primary Peritonitis, which happens very rarely, is caused when a bacterial infection that begins in the blood or the lymph nodes spreads to the peritoneum. Sometimes, other body fluids like urine or pancreatic juice may leak out of their respective organs, become infected, and make their way into the peritoneum. Patients suffering from liver disease are more prone to this type of Peritonitis.

The more common kind, secondary Peritonitis occurs when the peritoneum is contaminated by bacteria or enzymes which make their entrance from a tear or rupture in the digestive or biliary tract. Some perforations are caused by conditions like peptic ulcers, a ruptured appendix, inflammatory bowel disease (IBD), or colorectal cancer. Sometimes the tear may be the result of traumas caused by a sharp object like a fish bone or toothpick, a stab wound, or invasive procedures like an endoscopy, catheter insertion or even abdominal surgery.

Peritonitis may also cause complications like shock and acute renal failure brought about by electrolyte disturbances, peritoneal abscesses, and sepsis, an infection of the body and blood that can result in multiple organ failure. Other complications include abnormal blood clotting, lung infection, and fibrous tissue growth in the peritoneum.

People who have liver disease like cirrhosis, kidney disorders, excessive abdominal fluids, pelvic inflammatory disease and a weakened immune system have a higher risk for contracting primary Peritonitis. The chances of contracting secondary Peritonitis increases with ailments like appendicitis, peptic ulcers, intestinal and pancreatic disorders, gallbladder inflammation, inflammatory bowel disease, injuries from surgical procedures, and physical trauma to the abdominal area.

To treat Peritonitis, the doctor will conduct a physical examination of the abdominal region to determine whether any pain is accompanied by tenderness or rigidity, and an absence of sounds in the bowel. The doctor will also check the patient's breathing rate, blood pressure, and look for any signs of dehydration. The doctor may also order abdominal or chest x-rays to check for the presence of air in the abdominal cavity. This signals the presence of a tear or perforation in any one of the abdominal organs.

Other diagnostic tests will include taking blood samples to check for the presence of microorganisms, taking samples of fluid from the abdomen, or a CT scan to verify the presence of pus or infected organs.

There are various treatments for Peritonitis, depending on how severe the patient's case is. Peritonitis is a life-threatening condition and may necessitate emergency medical attention. The most common procedure for the disease is called a laparotomy, a type of abdominal surgery which involves a thorough exploration and cleansing of the peritoneum to remove all traces of the infection and drain any excess fluid. If necessary, the surgeon will also correct any tears or perforations, such as occurs when an appendix or ulcer has burst, that may have caused the infection.

The patient will also require an intravenous drip to replace any electrolytes lost due to dehydration, as well as a round of broad-spectrum antibiotics, such as cefoxitin or clindamycin, administered directly to the peritoneum or intravenously to halt the infection. To relieve the pain caused by Peritonitis, the patient may be given analgesics or opiate medication. The doctor may also prescribe vitamin or herbal therapy to strengthen the patient during recovery from Peritonitis.

To hasten the improvement of the patient's condition, the doctor may also recommend a healthy diet, which includes eliminating food that may cause allergies such as dairy products, wheat or corn, and preservatives or additives.

Preventing the occurrence of Peritonitis and its accompanying complications will necessitate seeking immediate medical attention as soon as symptoms begin to manifest themselves. Peritonitis is a fatal disease but can be corrected if properly treated. The mortality rate for healthy individuals is 10%, but rises to 40% if the patient is elderly or is already suffering from an underlying ailment. For primary Peritonitis, the prognosis is poor for adults, particularly if the infection is secondary to a liver disease like cirrhosis. However, children recover completely from primary Peritonitis after intensive broad-spectrum antibiotic treatment.

Medical research is currently being undertaken to examine the effect of the drug meropenem in patients suffering from Peritonitis caused by septic shock. The study will take a close look at the peritoneal fluid of patients who will have microdialysis catheters inserted into the peritoneal cavity during the course of surgery. After concentrations of meropenem are administered via these catheters, its concentrations in both plasma and the peritoneal fluid will be analyzed to determine the proper recommended dosage regimen sufficient to eradicate the infection-causing bacteria.