Secondary peritonitis is a medical condition where the peritoneum, the membrane lining the abdominal cavity and organs, becomes inflamed. This inflammation results from an infection originating from an internal abdominal organ. It is distinct from primary peritonitis, where infection arises without an obvious source of contamination.
Understanding the Causes
Secondary peritonitis arises when bacteria or other irritating substances enter the peritoneal cavity, usually due to a breach in an abdominal organ. Common causes include a ruptured appendix, spilling infected contents into the abdomen. Similarly, a perforated stomach ulcer can allow digestive juices and food to leak, triggering inflammation and infection.
Diverticulitis, an inflammation of small pouches in the colon, can also lead to bowel perforation, releasing fecal matter and bacteria. Other origins include injuries like stab or gunshot wounds that directly introduce bacteria, or complications from medical procedures such as peritoneal dialysis if hygiene protocols are not strictly followed. Pancreatitis, or inflammation of the pancreas, can release digestive enzymes into the peritoneal cavity, which can cause a chemical peritonitis that may become infected.
Recognizing Symptoms and Diagnosis
Individuals with secondary peritonitis often present with severe abdominal pain that worsens with movement or touch. The abdomen may appear distended or bloated, and patients may develop a fever and chills. Other symptoms include nausea, vomiting, loss of appetite, thirst, and reduced urine output. In severe cases, signs of shock, such as low blood pressure, rapid heart rate, and confusion, may be observed.
Diagnosis begins with a physical examination, where medical professionals may note tenderness and rigidity of the abdomen. Blood tests are performed to check for infection markers, such as an elevated white blood cell count. Imaging studies, including X-rays or computed tomography (CT) scans, are used to identify the source of contamination, such as a perforation, or to detect fluid collections. In some cases, peritoneal fluid may be collected and analyzed for bacteria.
Treatment Approaches
Treating secondary peritonitis involves immediate medical intervention, often starting with emergency surgery. The primary goal of surgery is to identify and address the source of contamination within the abdominal cavity. This might involve repairing a perforation in the bowel or stomach, removing an inflamed appendix, or draining an abscess. The surgeon also cleans the peritoneal cavity to remove pus, blood, and other infectious material.
Alongside surgical repair, broad-spectrum antibiotics are administered intravenously to combat the bacterial infection. These medications target a wide range of bacteria commonly found in abdominal infections. Supportive care is also provided to stabilize the patient, including intravenous fluids for hydration and blood pressure, and pain management. A tube may be inserted through the nose into the stomach or intestine (nasogastric tube) to decompress the digestive tract and prevent further spillage. Surgical source control and antibiotic therapy are important for successful outcomes.
Potential Complications and Recovery
If secondary peritonitis is not treated promptly, it can lead to serious complications. One serious outcome is sepsis, a widespread infection that can result in organ failure throughout the body. Abscess formation, a localized collection of pus within the abdomen, is another possible complication. These complications highlight the need for rapid diagnosis and intervention.
The recovery process following secondary peritonitis varies depending on the severity of the initial infection and the patient’s overall health. Patients require hospitalization for continued antibiotic therapy and monitoring. Follow-up care is important to ensure complete resolution of the infection and to address any lingering issues, such as adhesions, bands of scar tissue that can potentially cause future bowel blockages. The outlook ranges from full recovery to more prolonged issues, influenced by how quickly treatment was initiated.