Alternate Names: Spontaneous peritonitis

Causes and Risks:

Most cases of bacterial peritonitis occur:

• When fluid (ascites) accumulates in the peritoneal cavity because of chronic liver disease, which keeps the fluid from being reabsorbed.
• In renal failure patients undergoing peritoneal dialysis. In these patients, the cause of spontaneous peritonitis is infection in the blood that spreads to the peritoneal fluid, usually from a contaminated peritoneal dialysis catheter.

Risk factors for liver disease include alcoholic cirrhosis and other diseases that lead to cirrhosis, such as viral hepatitis. Patients with renal failure can develop nephrotic syndrome, which leads to ascites, which can then become infected. Other risk factors include abdominal infections such as peptic ulcer disease, appendicitis, or diverticulitis cause peritonitis. Spontaneous peritonitis is rare in children.

Prevention:

There are no preventatives once alcoholic cirrhosis has developed. Early avoidance of excess alcohol use would prevent this risk factor.

Symptoms:

• Fluid in the abdomen
• Abdominal pain
• Point tenderness
• Abdominal distention
• Inability to pass feces or gas
• Fever
• Thirst
• Low urine output

• Nausea and vomiting
• Joint pain
• Chills

Signs and Tests: Tests that show infection:

• Culture of peritoneal fluid
• Chemical examination of peritoneal fluid
• Peritoneal fluid analysis(paracentesis)
• Cytologic examination (cell studies) of peritoneal fluid
• Blood culture

• Abdominal X-ray to rule out other causes of abdominal pain
• Laparotomy exploratory
• WBC (nuclear) scan

Treatment:

Treatment depends on the cause of the peritonitis. Surgery is indicated in the unlikely presence of appendicitis or repair of an intestinal perforation (hole). Antibiotics are administered to control infection in cases of spontaneous peritonitis in patients with liver or kidney disease, and dehydration is treated by intravenous therapy. Hospitalization is common.

Prognosis:

The infection can usually be treated, but the outcome may be poor because of underlying kidney or liver disease. Affected individuals often respond to antibiotics but may still have a poor outcome.

Complications:

• Abscess development
• Intestinal obstruction from scar tissue
• Hepatorenal syndrome
• Hepatic encephalopathy

Call your health care provider if you have symptoms of peritonitis; this can quickly become an emergency situation!