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Overview

What Is Peritonitis?

Peritonitis is inflammation of the peritoneum, the thin lining that surrounds many organs inside the abdomen. Infection, leakage of substances such as digestive fluids, or other irritation can cause it. Peritonitis can affect anyone, but the risk is higher after abdominal surgery, an abdominal injury, or with certain illnesses and medical treatments. Without urgent treatment, it can become life-threatening.

Emergency Warning Signs

Emergency Warning Signs of Peritonitis

Emergency warning

Get emergency medical help now

Seek emergency care immediately if peritonitis is possible. Call emergency services for severe symptoms or signs that the illness is affecting the whole body.

  • Severe or worsening abdominal pain
  • A rigid or very tender abdomen
  • Fever or chills
  • Repeated vomiting
  • Inability to pass stool or gas
  • Faintness or confusion
  • Pale, clammy skin, rapid breathing, or other signs of shock

Peritonitis can worsen quickly and should not be monitored at home. Get urgent medical help, especially if symptoms follow abdominal surgery, an injury, a gastrointestinal perforation, or occur in someone receiving peritoneal dialysis.

Symptoms

Peritonitis Symptoms

  • Severe or worsening abdominal pain can be a key symptom.
  • Abdominal tenderness may make even light touch painful.
  • A swollen abdomen can develop from inflammation or fluid buildup.
  • Abdominal rigidity can make the belly feel hard or tense.
  • Fever may occur as the body responds to infection.
  • Chills can accompany a serious infection.
  • Nausea may occur with abdominal inflammation.
  • Vomiting can develop and may become repeated.
  • Loss of appetite is common during serious abdominal illness.
  • Diarrhea or constipation may occur when inflammation affects the intestines.
  • Reduced urine can be a sign of dehydration or worsening illness.
  • A rapid heartbeat may occur with infection, pain, or shock.
  • Weakness can develop as the illness progresses.
  • Dizziness may result from dehydration or low blood pressure.
  • Confusion can signal severe infection or reduced blood flow to the brain.

Causes

Peritonitis Causes

Peritonitis may be infectious or noninfectious. Bacterial infection is a common mechanism when bacteria enter the normally protected abdominal cavity, but leakage of digestive fluids, bile, urine, or other substances can also inflame the peritoneum.

Types of peritonitis

Primary, or spontaneous, peritonitis usually develops without an obvious perforation, often in people with liver disease and ascites or those receiving peritoneal dialysis. Secondary peritonitis results from a ruptured appendix, bowel perforation, diverticulitis, pancreatitis, abdominal surgery, trauma, or another damaged organ. Tertiary peritonitis is a persistent or recurrent infection after treatment. Other causes include a ruptured appendix, bowel perforation, abdominal surgery, or leakage of bile, stomach contents, stool, or urine; this chemical irritation can begin before an infection develops.

Risk Factors

Peritonitis Risk Factors

Factors you may reduce

Risk can increase with peritoneal dialysis catheter contamination, poor hand hygiene during exchanges, inadequate wound or catheter care, untreated abdominal infections, and failure to follow postoperative instructions. Promptly reporting cloudy dialysis fluid or abdominal pain and completing prescribed infection treatment may reduce risk.

Underlying risks

Underlying risks include recent abdominal surgery or procedures, gastrointestinal disease, a weakened immune system, liver disease with ascites, and older age. These factors cannot always be changed, but careful medical follow-up can help identify problems early.

Having a risk factor does not mean someone will develop peritonitis. People with these risks should follow catheter-care, wound-care, and infection-treatment instructions closely and report concerning symptoms without delay.

Complications

Peritonitis Complications

  • Sepsis can occur when the infection triggers a dangerous whole-body response.
  • Septic shock can cause critically low blood pressure and poor blood flow to vital organs.
  • Organ failure may affect the kidneys, lungs, heart, or other organs.
  • Intra-abdominal abscesses may form as pockets of infected fluid.
  • Intestinal blockage from adhesions can develop during healing.
  • Prolonged hospitalization may be needed for severe infection or surgery.
  • Peritonitis can recur if the underlying source is not fully controlled.
  • Death can occur when severe peritonitis is not treated promptly or cannot be controlled.

The risk of complications rises when treatment is delayed or when the underlying source of contamination cannot be controlled. Early emergency assessment helps clinicians stabilize the person and address the cause.

Diagnosis

How Peritonitis Is Diagnosed

A clinician will assess abdominal pain, tenderness, guarding, rigidity, fever, and vital signs. They will also ask about recent surgery, peritoneal dialysis, injuries, and possible abdominal infection or perforation.

Tests for peritonitis

Blood tests can look for signs of infection, inflammation, dehydration, and organ stress. Abdominal ultrasound or CT may show inflammation, fluid, perforation, or an abscess. Paracentesis or other peritoneal-fluid analysis can examine the fluid for cells and bacteria, with cultures used when bacterial infection is suspected.

Testing is used not only to confirm inflammation or infection but also to locate the source, determine severity, and guide antimicrobial treatment. In some emergencies, treatment may begin before every test result is available.

Treatment Options

Peritonitis Treatment Options

Antibiotics and hospital support

People with suspected bacterial peritonitis may receive antibiotics through a vein or through dialysis, along with intravenous fluids, pain control, oxygen, and support for affected organs. Treatment is selected according to the suspected organisms, culture results, kidney function, dialysis status, illness severity, and whether sepsis is present. Severe illness requires close inpatient monitoring, while early recovery may include gradual return of eating, movement, and normal bowel function.

Source-control procedures or surgery

A procedure may drain an abscess, repair a perforation, remove an infected or damaged organ, wash out the abdomen, or manage a contaminated dialysis catheter. These treatments are used when antibiotics alone cannot control the source, particularly when there is a perforation, abscess, damaged tissue, or persistent infection. Recovery depends on the underlying cause, procedure performed, complications, and how quickly bowel function returns.

Prevention

Can Peritonitis Be Prevented?

  • Use careful hand hygiene and sterile technique during peritoneal dialysis exchanges.
  • Report cloudy dialysis fluid or new abdominal pain promptly to the dialysis team.
  • Keep surgical wounds and catheters clean and follow care instructions.
  • Seek timely treatment for abdominal infections.
  • Follow postoperative instructions about wound care, activity, diet, and warning signs.

Not every case can be prevented. Prevention focuses on reducing contamination and treating conditions that can lead to leakage, abdominal injury, or infection.

Outlook and Prognosis

Peritonitis Outlook and Prognosis

Many people recover when peritonitis is treated promptly. Severe infection, delayed treatment, organ failure, resistant bacteria, or an uncontrolled abdominal source can worsen the prognosis and increase the risk of complications.

Recovery and follow-up

Recovery may involve completing antibiotics, monitoring for recurrent pain or fever, and gradually restoring nutrition and activity. Follow-up is important for treating the underlying condition and checking a dialysis access site when relevant. Recovery time varies from days to weeks or longer depending on surgery, complications, and pre-existing health conditions.

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