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Peritonitis - secondary

Peritonitis - secondary


Secondary peritonitis

Secondary peritonitis is an inflammation of the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. It is called the peritoneum.

Secondary means it is due to another condition. It is most often caused by an infection that spreads from the digestive tract.

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  • Causes

    Secondary peritonitis has several major causes. Bacteria may enter the peritoneum through a hole (perforation) in the gastrointestinal tract. The hole may be caused by a ruptured appendix, stomach ulcer, or perforated colon. It may also come from an injury, such as a gunshot or knife wound.

    Secondary peritonitis can also occur when bile or chemicals released by the pancreas (pancreatic enzymes) leak into the lining of the abdominal cavity.

    Substances from outside the body can also cause secondary peritonitis if they get into the peritoneal cavity. This can occur during use of peritoneal dialysis catheters or feeding tubes.

    Inflammation of the peritoneal cavity caused by bacteria can cause an infection of the bloodstream (sepsis). This is a severe illness.

    Secondary peritonitis can also affect premature babies who have necrotizing enterocolitis.

  • Symptoms

    • Abdominal distention (swelling)
    • Abdominal pain
    • Decreased appetite
    • Fever
    • Low urine output
    • Nausea
    • Thirst
    • Vomiting

    Note: There may be signs of shock.

  • Exams and Tests

    During a physical exam, the health care provider may notice abnormal vital signs with fever, rapid heart rate and breathing, and low blood pressure.

    Tests may include:

    • Blood culture
    • Blood chemistry, including pancreatic enzymes
    • Complete blood count
    • Liver and kidney function tests
    • X-rays or CT scan
    • Peritoneal fluid culture
    • Urinalysis

  • Treatment

    Often, surgery is needed to remove sources of infection. These may be an infected bowel, an inflamed appendix, or an abscess.

    General treatment includes:

    • Antibiotics
    • Fluids through a vein (IV)
    • Pain medicines
    • Tube through the nose into the stomach or intestine (nasogastric or NG tube)
  • Outlook (Prognosis)

    The outcome can range from complete recovery to overwhelming infection and death. Factors that determine the outcome include:

    • How long the symptoms were present before treatment began
    • The person's general health
  • Possible Complications

    • Abscess
    • Gangrene (dead) bowel
    • Intraperitoneal adhesions ( (a potential cause of future bowel blockage)
    • Septic shock
  • When to Contact a Medical Professional

    Call your health care provider if you have symptoms of peritonitis. This is a serious condition. It needs emergency medical treatment in most cases.

Related Information

  BileBiliary systemNecrotizing entero...Septic shockAdhesion    


Turnage RH, Badgwell B. McDonald JC. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 45.

Wyers SG, Matthews JB. Surgical peritonitis and other diseases of the peritoneum, mesentery, omentum, and diaphragm. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Saunders Elsevier; 2010:chap 37.


Review Date: 8/11/2014  

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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