Peritonitis - secondary

Definition

Secondary peritonitis is an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.

Secondary means it is due to another condition, most commonly the spread of an infection from the digestive tract.

Alternative Names

Secondary peritonitis

Causes

Secondary peritonitis has several major causes. Bacteria may enter the peritoneum through a hole (perforation) in the gastrointestinal tract. Such a hole may be caused by a ruptured appendix, stomach ulcer, perforated colon, or injury, such as a gunshot or knife wound.

Secondary peritonitis can also occur when bile or chemicals released by the pancreas (pancreatic enzymes) leak into the lining of the abdominal cavity.

Foreign contaminants can also cause secondary peritonitis if they get into the peritoneal cavity. This can occur during use of peritoneal dialysis catheters or feeding tubes.

Inflammation of the peritoneal cavity caused by bacteria can result in infection of the bloodstream (sepsis) and severe illness.

Secondary peritonitis can also affect premature babies who have necrotizing enterocolitis.

Symptoms

• Abdominal distention (swelling)
• Abdominal pain
• Decreased appetite
• Fever
• Low urine output
• Nausea
• Thirst
• Vomiting

Note: There may be signs of shock.

Exams and Tests

Vital signs may be abnormal with fever, rapid heart rate and breathing, and low blood pressure.

Tests may include:

• Blood culture
• Blood chemistry, including pancreatic enzymes
• Complete blood count
• Liver and kidney function tests
• X-rays or CT scan
• Peritoneal fluid culture
• Urinalysis

Treatment

Surgery is usually necessary to remove sources of infection such as an infected bowel, inflamed appendix, or abscess.

General treatment includes:

• Antibiotics
• Fluids through a vein (IV)
• Pain medicines
• Tube through the nose into the stomach or intestine (nasogastric or NG tube)

Outlook (Prognosis)

The outcome depends on the underlying cause, the duration of symptoms before treatment, and the general health of the patient. Outcomes can range from complete recovery to overwhelming infection and death, depending on these factors.

Possible Complications

• Abscess
• Gangrene (dead) bowel
• Intraperitoneal adhesions ( (a potential cause of future bowel blockage)
• Septic shock

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of peritonitis. This is a serious condition that typically requires emergency medical treatment.

References

Turnage RH, Richardson KA, Li BD, McDonald JC. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 43.

Wyers SG, Matthews JB. Surgical peritonitis and other diseases of the peritoneum, mesentery, omentum, and diaphragm. In: Feldman M, FriedmanLS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 37.

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