Peritonitis
What is Peritonitis?
Peritonitis is an inflammation of the peritoneum, the thin tissue that lines your abdomen and covers most abdominal organs. This condition is usually caused by a bacterial or fungal infection. It requires urgent medical attention because it can become life threatening quickly.
The peritoneum acts as a protective barrier for your organs. When it becomes inflamed, fluid and pus can build up in your belly. This causes severe pain and prevents your digestive system from working normally. Peritonitis can happen suddenly or develop slowly over time.
Most cases result from a hole in your intestine or another abdominal organ. This allows bacteria to leak into the sterile space of your abdomen. Less commonly, peritonitis develops in people on dialysis or from infections spreading through the bloodstream. Early diagnosis and treatment are critical to prevent serious complications.
Symptoms
- Severe abdominal pain that worsens with movement or touch
- Abdominal swelling or bloating
- Fever and chills
- Nausea and vomiting
- Loss of appetite
- Inability to pass stool or gas
- Reduced urine output
- Fatigue and weakness
- Rapid heartbeat
- Low blood pressure
Some people with early peritonitis may only notice mild discomfort or bloating. However, symptoms typically progress rapidly and become severe within hours. Anyone experiencing sudden, intense abdominal pain should seek emergency medical care immediately.
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Causes and risk factors
Peritonitis most commonly occurs when bacteria or fungi enter the peritoneum through a rupture in the abdominal wall or digestive tract. A ruptured appendix is one of the leading causes. Stomach ulcers, diverticulitis, and pancreatitis can also create holes that leak digestive fluids and bacteria into the abdomen. Abdominal trauma from injuries or surgery can introduce infection as well.
People who undergo peritoneal dialysis for kidney failure face higher risk of infection through their dialysis catheter. Liver disease with fluid buildup, called ascites, can become infected and lead to spontaneous bacterial peritonitis. Other risk factors include inflammatory bowel disease, pelvic inflammatory disease, and any condition that weakens the immune system. Chemical peritonitis can occur when bile, blood, or other sterile fluids irritate the peritoneum without infection.
How it's diagnosed
Doctors diagnose peritonitis through physical examination, blood tests, and imaging studies. Your doctor will press on your abdomen to check for tenderness, rigidity, and guarding. Blood tests can reveal infection markers, including elevated white blood cell count. Rite Aid offers blood testing that measures WBC and CA-125 levels, which help identify peritoneal inflammation and infection. These biomarkers provide important clues when peritonitis is suspected.
Additional tests may include CT scans or X-rays to look for holes in your digestive organs or fluid in your abdomen. Your doctor may also perform paracentesis, removing a small sample of abdominal fluid with a needle to test for bacteria. Early diagnosis is critical because peritonitis can lead to sepsis and organ failure without prompt treatment. Testing at Quest Diagnostics locations makes it easier to monitor inflammatory markers if you have risk factors.
Treatment options
- Immediate hospitalization for intravenous antibiotics or antifungal medications
- Surgery to remove infected tissue, repair perforations, or drain abscesses
- Intravenous fluids to prevent dehydration and support blood pressure
- Pain medication to manage severe abdominal discomfort
- Nutritional support through feeding tubes or IV nutrition during recovery
- Treatment of underlying conditions like appendicitis or ulcers
- Dialysis changes or catheter removal for peritoneal dialysis patients
- Rest and gradual return to normal eating as inflammation resolves
Peritonitis requires emergency medical treatment. Most people need surgery within hours of diagnosis to remove the source of infection. Antibiotic therapy typically continues for several weeks. Recovery time varies but often requires a hospital stay of one to two weeks. Long-term complications can include adhesions and intestinal blockages. Anyone with abdominal pain, fever, and vomiting should see a doctor immediately.
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Frequently asked questions
Most cases of peritonitis result from a bacterial infection that enters the abdomen through a rupture or perforation. Common causes include a ruptured appendix, perforated stomach ulcer, or complications from abdominal surgery. Less often, peritonitis develops from infections spreading through the bloodstream or from peritoneal dialysis catheters.
Peritonitis is a medical emergency that can become life threatening within hours. The infection can spread rapidly through the bloodstream, leading to sepsis and organ failure. Anyone experiencing severe abdominal pain, fever, and vomiting should seek immediate medical attention. Early treatment with antibiotics and surgery dramatically improves survival rates.
Blood tests can reveal signs of peritoneal inflammation and infection. An elevated white blood cell count indicates your body is fighting infection. CA-125 levels may also rise with peritoneal inflammation. These biomarkers help doctors assess the severity of infection and monitor treatment response, though imaging and physical exam remain critical for diagnosis.
Peritonitis causes severe, constant abdominal pain that worsens with any movement or pressure. Many people describe it as a sharp, intense pain across the entire belly. The abdomen often becomes rigid and tender to touch. Pain may be accompanied by fever, nausea, and inability to pass gas or stool.
Most cases of peritonitis require surgery to remove the infection source and clean the abdominal cavity. Some mild cases, particularly spontaneous bacterial peritonitis in people with liver disease, may respond to antibiotics alone. However, peritonitis with organ perforation or abscess formation almost always needs surgical intervention. Your doctor will determine the best treatment approach based on the underlying cause.
People undergoing peritoneal dialysis face increased risk due to catheter-related infections. Those with liver disease and ascites can develop spontaneous bacterial peritonitis. Other high-risk groups include people with inflammatory bowel disease, recent abdominal surgery, or weakened immune systems. Anyone with a ruptured appendix or perforated ulcer can develop peritonitis suddenly.
Recovery time depends on the severity of infection and whether surgery was needed. Most people spend one to two weeks in the hospital receiving intravenous antibiotics. Full recovery at home may take several additional weeks. Some people experience long-term complications like adhesions or scar tissue that can cause ongoing digestive issues.
Peritonitis can recur, especially in people on peritoneal dialysis or those with chronic liver disease. Proper catheter care reduces infection risk in dialysis patients. Treating underlying conditions like inflammatory bowel disease helps prevent future episodes. Following your doctor's instructions about wound care and medication is essential to prevent recurrence.
Untreated peritonitis can lead to sepsis, a life-threatening bloodstream infection that causes organ failure. Other complications include abscesses, adhesions that block the intestines, and difficulty absorbing nutrients. Some people develop blood clots or respiratory problems. With prompt treatment, most people recover fully, though some face long-term digestive issues.
Prevention focuses on treating conditions that can lead to organ rupture, like appendicitis or ulcers. People on peritoneal dialysis should follow strict sterile techniques when handling their catheter. Seeking prompt treatment for abdominal pain or infections reduces risk. Maintaining good nutrition and managing chronic conditions like inflammatory bowel disease also helps lower your risk.