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Peritonitis

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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. It can result from any rupture (perforation) in your abdomen, or as a complication of other medical conditions. Peritonitis may be localized or generalized, and may result from bacterial or funal infection (often due to perforation of the intestinal tract as may occur in abdominal trauma or inflamed appendix) or from a non-infectious process.

Causes of Peritonitis

  • The two main types of peritonitis are primary spontaneous peritonitis, an infection that develops in the peritoneum; and secondary peritonitis, which usually develops when an injury or infection in the abdominal cavity allows infectious organisms into the peritoneum. Both types of peritonitis are life-threatening. The death rate from peritonitis depends on many factors, but can be as high as 40% in those who also have cirrhosis. As many as 10% may die from secondary peritonitis.

Infection

  • Perforation of part of the gastrointestinal tract is the most common cause of peritonitis.
    • Examples include perforation of the distal esophagus (Boerhaave syndrome), of the stomach (peptic ulcer, gastric carcinoma), of the duodenum (peptic ulcer), of the remaining intestine (e.g., appendicitis, diverticulitis, Meckel diverticulum, inflammatory bowel disease (IBD), intestinal infarction, intestinal strangulation, colorectal carcinoma, meconium peritonitis), of the gallbladder (cholecystitis).
    • Other possible reasons for perforation include abdominal trauma, ingestion of a sharp foreign body (such as a fish bone, toothpick or glass shard), perforation by an endoscope or catheter, and anastomotic leakage. The latter occurrence is particularly difficult to diagnose early, as abdominal pain and ileus paralyticus are considered normal in patients who have just undergone abdominal surgery.
    • In most cases of perforation of a hollow viscus, mixed bacteria are isolated; the most common agents include Gram-negative bacilli (e.g., Escherichia coli) and anaerobic bacteria (e.g., Bacteroides fragilis). Fecal peritonitis results from the presence of faeces in the peritoneal cavity. It can result from abdominal trauma and occurs if the large bowel is perforated during surgery.
  • Disruption of the peritoneum, even in the absence of perforation of a hollow viscus, may also cause infection simply by letting micro-organisms into the peritoneal cavity.
    • Examples include trauma, surgical wound, continuous ambulatory peritoneal dialysis, and intra-peritoneal chemotherapy. Again, in most cases, mixed bacteria are isolated; the most common agents include cutaneous species such as Staphylococcus aureus, and coagulase-negative staphylococci, but many others are possible, including fungi such as Candida.[3]
  • Spontaneous bacterial peritonitis (SBP) is a peculiar form of peritonitis occurring in the absence of an obvious source of contamination.
    • Peritonitis that develops without an abdominal rupture (spontaneous peritonitis) is usually a complication of liver disease, such as cirrhosis.
    • It occurs in patients with ascites, in particular, in children.
  • Intra-peritoneal dialysis predisposes to peritoneal infection (sometimes named "primary peritonitis" in this context).
  • Systemic infections (such as tuberculosis) may rarely have a peritoneal localisation.
  • Pelvic inflammatory disease

Non-infection

  • Leakage of sterile body fluids into the peritoneum,
    • such as blood (e.g., endometriosis, blunt abdominal trauma), gastric juice (e.g., peptic ulcer, gastric carcinoma), bile (e.g., liver biopsy), urine (pelvic trauma), menstruum (e.g., salpingitis), pancreatic juice (pancreatitis), or even the contents of a ruptured dermoid cyst.
    • It is important to note that, while these body fluids are sterile at first, they frequently become infected once they leak out of their organ, leading to infectious peritonitis within 24 to 48 hours.
  • Sterile abdominal surgery, under normal circumstances, causes localised or minimal generalised peritonitis, which may leave behind a foreign body reaction or fibrotic adhesions.
    • However, peritonitis may also be caused by the rare case of a sterile foreign body inadvertently left in the abdomen after surgery (e.g., gauze, sponge).
  • Much rarer non-infectious causes may include familial Mediterranean fever, TNF receptor associated periodic syndrome, porphyria, and systemic lupus erythematosus.

Risk factors

  • Previous history of peritonitis
  • Ruptured appendix, diverticulum or stomach ulcer
  • Pancreatitis
  • Perforations of the stomach, intestine, gallbladder or appendix
  • Surgery
  • History of alcoholism
  • Liver disease (with cirrhosis)
  • Kidney failure (on peritoneal dialysis)
  • Fluid accumulation in the abdomen (such as bile, blood, or foreign substances in the abdomen such as barium.)
  • Weakened immune system
  • Pelvic inflammatory disease
  • Trauma to the abdomen, such as an injury from a knife or gunshot wound

Prognosis

  • If properly treated, typical cases of surgically correctable peritonitis (e.g., perforated peptic ulcer, appendicitis, and diverticulitis) have a mortality rate of about <10% in otherwise healthy patients.
  • The mortality rate rises to about 40% in the elderly, or in those with significant underlying illness, as well as cases that present late (after 48 hours).
  • Without being treated, generalized peritonitis almost always causes death.
    • The stage magician Harry Houdini died this way, having contracted streptococcus peritonitis after his appendix ruptured and was removed too late to prevent spread of the infection.
  • In 2015, it killed 817 people as the underlying cause of death in the United States. Additionally, it was involved in 3,261 other deaths as a contributing cause. The sex, race, and age group killed at the highest rate were men, White people, and ages 85+.
  • During 1999-2015, and adjusting for age distributions between locations, Acute peritonitis was most deadly in Rhode Island, followed by Nevada, and then Michigan. It was least deadly in Florida, Utah, and Washington.

Famous People Who Died of Peritonitis:

  1. Ranker - Famous People Who Died of Peritonitis (81 people listed)
  2. Wikipedia - Deaths from Peritonitis (101 people listed)

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