Peritonitis or inflammation of the peritoneum is an acute process that causes intense abdominal pain, among other symptoms. Treatment depends on its causes but usually requires the use of surgery and antibiotics.
Peritonitis is the inflammation of the peritoneum or peritoneal cavity due to infection, trauma, or chemical irritants such as pancreatic juice, intestinal, or bile.
The peritoneum is a membrane that surrounds most of the organs located in the abdomen. It is made up of two layers, an external one called the parietal peritoneum, which is in contact with the abdominal wall.
An internal one, called the visceral peritoneum, is in direct contact with the abdominal organs. Between them is a space called the peritoneal cavity, where there is a small amount of fluid, which allows the sliding between the two layers of the peritoneum.
Why Peritonitis Occurs
Peritonitis is usually an acute process. It occurs quickly and can affect any area of the peritoneum (localized peritonitis) or all of it (generalized peritonitis). It is classified into three large groups:
- Primary peritonitis: it generally occurs in patients with ascites (presence of a large amount of fluid in the peritoneal cavity, due in most cases to chronic liver disease such as cirrhosis ), or in patients undergoing peritoneal dialysis (peritoneal dialysis is a technique with which fluids and electrolytes are purified in patients with kidney malfunction, thanks to the action of the peritoneum, which acts as a filter).
- Peritonitis secondary to different causes: perforation of a hollow abdominal viscus (stomach, intestine), contamination by germs during surgery or a traumatic wound, by rupture of a collection of pus (abscess), and so on.
- Tertiary peritonitis: occurs in patients with a deplorable general condition (multi-organ failure) after abdominal surgery, probably due to the passage of germs into the peritoneal cavity from inside the intestinal lumen.
We can speak of several specific types of peritonitis: spontaneous bacterial peritonitis, secondary bacterial peritonitis, and intra-abdominal abscesses. Together with their symptoms, causes, diagnosis, and treatment, we will develop below.
Symptoms of peritonitis
The most important symptom of peritonitis is abdominal pain. It is usually abrupt and intense, and its location depends on the cause that produces the inflammation of the peritoneum.
When the infection progresses, the pain usually becomes general and affects the entire abdomen. It is often worse with movements and coughing, often causing the patient to bend the knees to prevent distension of the nerve fibers that supply the peritoneal cavity.
It is especially characteristic in secondary peritonitis that the patient tends to lie down, avoiding movements that worsen his pain. When the doctor examines the abdomen, he finds it especially hard, with intense pain after a decompression maneuver (pressing the abdomen and releasing suddenly).
If the process has been caused by severe infection or perforation, it may be accompanied by severe malaise, rapid heartbeat, and sweating.
Other symptoms that are usually present in peritonitis are fever, vomiting, or interruption of intestinal transit. The fever is usually more striking in secondary peritonitis, generally because the process that causes it is more abrupt in its appearance. Not so in spontaneous peritonitis, in which it is usual for the fever to be slight, usually not exceeding 38ºC.
In cases of spontaneous bacterial peritonitis, as in patients with cirrhosis, an increase in the perimeter of the abdomen is observed due to the presence of ascites or peritoneal fluid, accompanied by a hernia in the umbilicus. They can also cause decompensation of liver disease due to peritonitis, manifesting symptoms such as confusion or encephalopathy.