Peritonitis is inflammation of the peritoneum, the thin layer of tissue covering the inside of your abdomen and most of its organs. The inflammation is usually the result of a fungal or bacterial infection. This can be caused by an abdominal injury, an underlying medical condition, or a treatment device, such as a dialysis catheter or feeding tube.
Peritonitis is a serious condition that needs immediate medical attention. Prompt intravenous (IV) antibiotics are needed to treat the infection. Surgery is sometimes necessary to remove infected tissue. The infection can spread and become life-threatening if it isn’t treated promptly.
There are two types of peritonitis. Spontaneous bacterial peritonitis (SBP) is the result of an infection of the fluid in your peritoneal cavity. Kidney or liver failure can cause this condition. People on peritoneal dialysis for kidney failure are also at increased risk for SBP.
Secondary peritonitis is usually due to an infection that has spread from your digestive tract.
The following conditions can lead to peritonitis:
- an abdominal wound or injury
- a ruptured appendix
- a stomach ulcer
- a perforated colon
- pancreatitis, or inflammation of the pancreas
- cirrhosis of the liver or other types of liver disease
- infection of the gallbladder, intestines, or bloodstream
- pelvic inflammatory disease (PID)
- Crohn’s disease
- invasive medical procedures, including treatment for kidney failure, surgery, or the use of a feeding tube
Symptoms will vary depending on the underlying cause of your infection. Common symptoms of peritonitis include:
- tenderness in your abdomen
- pain in your abdomen that gets more intense with motion or touch
- abdominal bloating or distention
- nausea and vomiting
- constipation or the inability to pass gas
- minimal urine output
- anorexia, or loss of appetite
- excessive thirst
- fever and chills
If you’re on peritoneal dialysis, your dialysis fluid may appear cloudy or have white flecks or clumps in it. You may also notice redness or feel pain around your catheter.
If you have symptoms of peritonitis, seek medical attention right away. Delaying your treatment could put your life at risk.
Your doctor will ask you about your medical history and perform a complete physical exam. This will include touching or pressing on your abdomen, which will probably cause some discomfort.
Several other tests can help your doctor diagnose peritonitis:
- A blood test, called a complete blood count (CBC), can measure your white blood cell count (WBC). A high WBC count usually signals inflammation or infection. A blood culture can help to identify the bacteria causing the infection or inflammation.
- If you have a buildup of fluid in your abdomen, your doctor can use a needle to remove some and send it to a laboratory for fluid analysis. Culturing the fluid can also help identify bacteria.
- Imaging tests, such as CT scans and X-rays, can show any perforations or holes in your peritoneum.
If you’re on dialysis, your doctor may diagnose peritonitis based on the appearance of cloudy dialysis fluid.
The first step in treating peritonitis is determining its underlying cause. Treatment usually involves antibiotics to fight infection and medication for pain.
If you’re on kidney dialysis and have peritonitis, you may have to wait until the infection clears up to receive more dialysis. If the infection continues, you might need to switch to a different type of dialysis.
Your treatment must begin promptly to avoid serious and potentially fatal complications.
If it’s not treated promptly, the infection may enter your bloodstream, causing shock and damage to your other organs. This can be fatal.
The potential complications of spontaneous peritonitis include:
- hepatic encephalopathy, which is a loss of brain function that occurs when the liver can no longer remove toxic substances from your blood
- hepatorenal syndrome, which is progressive kidney failure
- sepsis, which is a severe reaction that occurs when the bloodstream becomes overwhelmed by bacteria
The complications of secondary peritonitis include:
- an intra-abdominal abscess
- gangrenous bowel, which is dead bowel tissue
- intraperitoneal adhesions, which are bands of fibrous tissue that join abdominal organs and can cause bowel blockage
- septic shock, which is characterized by dangerously low blood pressure
If you’re on dialysis, wash your hands and fingernails before touching your catheter. Clean the skin around the catheter daily. Follow your doctor’s instructions regarding the care and storage of your medical supplies.
If you have severe abdominal pain or an abdominal injury, such as a knife wound, take one of the following actions:
- see your doctor
- go to an emergency room
- call 911 or your local emergency services
The outlook for peritonitis depends on the cause of your infection and how far it progressed before treatment began. Medications and surgery are usually able to bring the infection under control.
If treatment doesn’t begin early, the infection can spread. If other organs are damaged, your recovery will depend on your overall health and how much damage was done.