Peritonitis - secondary

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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.

Alternative Names

Secondary peritonitis

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 or following the ingestion of a sharp foreign body.
  • 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:

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, low blood pressure, and a tender distended abdomen.

Tests may include:

Treatment

Often, surgery is needed to remove or treat sources of infection. These may be an infected bowel, an inflamed appendix, or an abscess or perforated diverticulum.

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 requiring surgery
  • 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.

Images

Peritoneal sample

References

Mathews JB, Turaga K. 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. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 39.

Turnage RH, Mizell J, 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. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 43.

Review Date: 
4/2/2020
Reviewed By: 
Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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