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Peritonitis Main Page
Patient Information
Overview
Causes
Classification Spontaneous Bacterial Peritonitis Secondary Peritonitis
Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Causes

Common causes Less common causes Spontaneous bacterial peritonitis Aerobic gram-negative bacteria, such as Escherichia coli Gram-positive cocci, such as  Streptococcus Enterococcus  Staphylococcus aureus Streptococcus salivarius Poly-microbial infection Secondary peritonitis Gram-negative bacilli (e.g. Escherichia coli),  Anaerobic bacteria (e.g. Bacteroides fragilis) Enterobacter cloacae Staphylococcus epidermidis Propionibacterium species Pseudomonas Enterococcus Candida

Classification

Peritonitis is classified based on the cause of the inflammatory process and the character of microbial contamination as follows:

Peritonitis                                                                                         Primary peritonitis         Secondary peritonitis         Tertiary peritonitis                                             ❑ Spontaneous peritonitis ❑ Peritonitis in patients with CAPD ❑ Tuberculous peritonitis                         ❑ Peritonitis without evidence for pathogens ❑ Peritonitis with fungi ❑ Peritonitis with low-grade pathogenic bacteria                                                                                                                               Acute perforation peritonitis ❑ Gastrointestinal perforation ❑ Intestinal ischemia ❑ Pelviperitonitis and other forms     Postoperative peritonitis ❑ Anastomotic leak ❑ Accidental perforation and devascularization     Post-traumatic peritonitis ❑ After blunt abdominal trauma ❑ After penetrating abdominal trauma

Differential diagnosis

Classification of acute abdomen based on etiology		Presentation	Symptoms				Signs			Diagnosis		Additional Findings
			Fever	Abdominal Pain	Diarrhea	Constipation	Guarding	Rebound Tenderness	Bowel sounds	Lab Findings	Imaging Findings
Common causes of Peritonitis	Primary Peritonitis	Spontateous Bacterial Peritonitis	✔	Diffuse	✘	✘	✘	✘	Diminished	Ascitic fluid PMN >250cells/mm³ Culture: Positive for single organism
	Secondary Peritonitis	Perforated gastric and duodenal ulcer	✔	Diffuse	✘	✘	✔	✔	✘	Glucose < 50mg/dl Ascitic fluid LDH > serum LDH Total Protein > 1g/dl
		Acute Cholangitis	✔	RUQ	✘	✘	✘	✘	N	Increased LFT
		Acute Cholecystitis	✔	RUQ	✘	✘	✘	✘	N
		Acute Pancreatitis	✔	Diffuse	✔	✘	✘	✘	N	Increased Amylase / Lipase
		Acute Appendicitis	✔	RLQ	✘	✘	✘	✔	N
		Acute Diverticulitis	✔	LLQ	✔/✘	✔/✘	✘	✘	N
		Acute Salphingitis	✔	LLQ/ RLQ	✘	✘	✔/✘	✔/✘	N
Hollow Viscous Obstruction		Small Intestine obstruction	✘	Diffuse	✘	✔✔	✘	✘	Absent
		Volvulus		LLQ
		Biliary Colic		RUQ
		Renal Colic		Flank Pain
Vascular Disorders	Ischemic causes	Mesentric Ischemia		Periumbilical						Increased AG Acidosis
		Acute Ischemic Colitis
	Hemorrhagic causes	Ruptured Abdominal Aortic Aneurysm		Diffuse
		Intraabdominal or Retroperitoneal Hemorrhage		Diffuse
Gynaecological Causes	Ovarian Cyst Complications	Torsion of the Cyst		RLQ / LLQ
		Cyst Rupture		RLQ / LLQ
	Pregnancy	Ruptured Ectopic Pregnancy		RLQ / LLQ						Positive Urine beta HCG