Peritonitis - secondary

Also known as: Secondary peritonitis

Definition

The peritoneum is the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. Peritonitis is present when this tissue becomes inflamed or infected. Secondary peritonitis is when another condition is the cause.

Causes

Secondary peritonitis has several major causes.

  • Bacteria may enter the peritoneum through a hole (perforation) in an of the organ digestive tract. The hole may be caused by a ruptured appendix, stomach ulcer, or perforated colon. It may also come from an injury, such as a gunshot or knife wound.
  • Bile or chemicals released by the pancreas may leak into the abdominal cavity. This may be caused by sudden swelling and inflammation of the pancreas.
  • Tubes or catheters placed into the abdomen may cause this problem. These include catheters for peritoneal dialysis, feeding tubes, and others.

An infection of the bloodstream (sepsis) may lead to an infection in the abdomen also. This is a severe illness.

This tissue may become infected when there is no clear cause.

Necrotizing enterocolitis occurs when the lining of the intestinal wall dies. This problem nearly always develops in an infant who is ill or born early.

Symptoms

Symptoms include:

  • Swollen abdomen when your belly area is bigger than usual
  • Abdominal pain
  • Decreased appetite
  • Fever
  • Low urine output
  • Nausea
  • Thirst
  • Vomiting

Note: There may be signs of shock.

Exams and Tests

During a physical exam, the health care provider may notice abnormal vital signs 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

Often, surgery is needed to remove or treat sources of infection. These may be an infected bowel, an inflamed appendix, or an 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 can range from complete recovery to overwhelming infection and death. Factors that determine the outcome include:

  • How long the symptoms were present before treatment began
  • The person's general health

Possible Complications

Complications may include:

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

When to Contact a Medical Professional

Call your provider if you have symptoms of peritonitis. This is a serious condition. It needs emergency treatment in most cases.

References

Turnage RH, Badgwell B. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 45.

Wyers SG, Matthews JB. Surgical peritonitis and other diseases of the peritoneum, mesentery, omentum, and diaphragm. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 38.

Review date:
November 05, 2016
Reviewed by:
Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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