Secondary peritonitis overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]
Synonyms and keywords:: Surgical peritonitis, Perforation peritonitis, Acute peritonitis, Acute abdomen.

Overview

Secondary peritonitis is a result of an inflammatory process in the peritoneal cavity secondary to inflammation, perforation, or gangrene of an intra-abdominal or retroperitoneal organ. Surgical intervention is typically required to treat these processes. Antibiotics play an adjunctive role in severe intra-abdominal infection. If left untreated, patients with Secondary peritonitis usually die due to life-threatening Sepsis and Shock.

Definition

Secondary peritonitis is defined as the infection of the peritoneum due to spillage of organisms into the peritoneal cavity resulting from hollow viscus perforation, anastomotic leak, ischemic necrosis, or other injuries of the gastrointestinal tract.

Diagnosis

Diagnostic Evaluation of Secondary Peritonitis

Ascitic fluid with PMN ≥250

Bile stained ascitic fluid

Ascitic fluid biluribin >6 mg/dl and ascitic fluid/serum bilurin >1

IF NO →

If yes BILIARY PERFORATION

Fulfilment of atleast 2 of the following diagnostic criteria: ❑ Total protein >1g/dl ❑ Glucose <60 mg/dl ❑ LDH >upper limit of normal

IF NO Ascitic PMN < baseline. After 48 hours of therapy with antibiotics

IF YES Free air or extravasation of contrast medium

IF YES SPONTANEOUS BACTERIAL PERITONITIS

IF NO

IF NO

IF YES PERFORATION PERITONITIS

NON-PERFORATIONAL SECONDARY PERITONITIS

No evidence for loculated infection

Evidence for loculated infection with U/S or Barium enema etc.

SPONTANEOUS BACTERIAL PERITONITIS ❑ Continue antibiotic

LAPAROTOMY