Peritonitis

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Peritonitis is an inflammation of the peritoneum, the tissue lining the abdominal cavity, primarily caused by bacterial or fungal infections.

These infections can arise from conditions such as a ruptured appendix, stomach ulcer, or intestinal perforation, which allow harmful bacteria to enter the abdominal cavity. Immediate treatment is necessary to prevent complications, including sepsis and organ failure.

Types of Peritonitis

There are three primary types of peritonitis, each distinguished by its underlying cause and progression.

Primary Peritonitis (Spontaneous Bacterial Peritonitis)

This type occurs without a direct cause within the abdomen and often affects individuals with liver disease and ascites, where bacteria from the intestines spread to the peritoneal fluid.

Secondary Peritonitis

This type results from a rupture or injury in the abdomen, such as a burst appendix or perforated ulcer, which allows bacteria from the digestive tract to infect the peritoneum.

Tertiary Peritonitis

This is a persistent infection that recurs after treatment for primary or secondary peritonitis, typically affecting individuals with weakened immune systems or critical illnesses.

Causes of Peritonitis

Peritonitis can occur due to various factors that introduce bacteria into the abdominal cavity. Common causes include:

  • Abdominal Injury: Surgical procedures or trauma can lead to bacterial contamination of the peritoneum.
  • Organ Rupture: Ruptured organs, like the appendix or intestine, release bacteria into the abdominal cavity.
  • Chronic Liver Disease: Conditions such as cirrhosis increase the risk of peritonitis due to fluid build-up (ascites).
  • Dialysis Complications: Peritoneal dialysis can raise infection risk if hygiene measures are not strictly followed.

Diagnosis of Peritonitis

Diagnosing peritonitis involves several key methods to confirm infection and determine the best course of treatment.

Physical Examination

The doctor will check for abdominal tenderness, rigidity, and swelling, which are key signs of inflammation and potential infection in the abdominal cavity.

Blood Tests

Blood tests detect elevated white blood cell counts and other infection markers, indicating an immune response to infection in the abdominal cavity and aiding diagnosis.

Imaging Tests

X-rays may reveal free air in the abdomen, a sign of organ perforation associated with secondary peritonitis. Ultrasound or CT scans identify fluid collections or abscesses, helping to assess the infection’s severity and spread.

Peritoneal Fluid Analysis

If there is fluid in the abdomen, a peritoneal fluid sample may be collected for analysis. Testing for bacteria or inflammatory cells confirms infection and helps guide treatment.

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Treatment Options for Peritonitis

Treatment for peritonitis depends on its cause and severity, with both non-surgical and surgical options available.

Non-Surgical Treatment
Antibiotics

Intravenous antibiotics are commonly prescribed as the first line of treatment, which help control the infection and reduce inflammation. Completing the full course of antibiotics is essential to ensure the infection is fully cleared and to reduce the risk of recurrence.

Pain Management

Over-the-counter pain relievers, such as paracetamol, may be used to alleviate discomfort during recovery.

Surgical Treatment

In severe cases of peritonitis, especially when complications such as organ rupture or abscesses occur, surgery may be required to prevent further issues and eliminate the source of infection.

Surgical Repair or Removal

This often involves repairing or removing the affected organ, such as the appendix or a segment of the intestine. This procedure helps prevent further contamination of the abdominal cavity.

Abscess Drainage

If abscesses form, they may need to be drained. This is typically performed using ultrasound or CT imaging guidance. The drainage can be done through a needle or a small incision to remove infected fluid, reducing pain and preventing the infection from spreading.

Prevention of Peritonitis

Preventing peritonitis involves managing risk factors, particularly for those with chronic conditions. Effective management of diseases like liver disease and diabetes can help lower the risk of developing peritonitis. Adhering to hygiene protocols during peritoneal dialysis is important to prevent infections. Timely treatment of abdominal infections or injuries, such as appendicitis or diverticulitis, is also key in avoiding complications. Overall, early intervention for these underlying issues can reduce the likelihood of developing peritonitis.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    What are the risks of untreated peritonitis?

    Untreated peritonitis can lead to severe complications, including sepsis, multi-organ failure, and bowel obstructions caused by scar tissue. In extreme cases, it can be life-threatening.

    Can peritonitis recur after treatment?

    Yes, particularly in individuals with chronic conditions like liver disease. In these cases, preventive antibiotics and regular check-ups may help reduce the risk of recurrence.

    How long does it take to recover from peritonitis?

    Recovery time varies based on infection severity and treatment type. Patients undergoing surgery or extensive antibiotic therapy may require several weeks to fully recover, especially if complications arise.

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