Inflammation of the peritoneum (peritonitis)

Inflammation of the peritoneum (peritonitis)

Peritonitis is a serious condition. If the inflammation of the peritoneum is not treated in time, it can be fatal. Typical signs are severe abdominal pain and a tense abdominal wall. In the following, you will discover which symptoms you can use to recognize peritonitis, what the course looks like and how the therapy is carried out.

What is peritonitis?

Peritonitis – also known as peritonitis in medical terminology – is, as the name suggests, an inflammation of the peritoneum. This is the skin that lines most of the abdominal organs. It enables the organs to slide against one another with little resistance. It is well innervated, i.e. strongly provided with nerves, and therefore susceptible to pain. Organs covered by the peritoneum include the liver, spleen, gallbladder, stomach, small intestine, urinary and genital organs, and parts of the oesophagus and large intestine.

Peritonitis can affect the entire peritoneum (generalized peritonitis) or only part (local peritonitis).


Causes: How does peritonitis begin?

Simply put, peritonitis can develop in three different ways:

  • by bacterial inflammation
  • by a chemical irritation
  • by irritation caused by metabolic products

In the case of bacterial infection, the peritoneum is inflamed directly by bacteria – mainly by the bacterium Escherichia coli. This occurs either when an organ in the peritoneum has a perforation (breakthrough) and the contents inside leak into the abdominal cavity or when intestinal bacteria migrate through the intestinal wall and thus enter the peritoneum. The latter can be the case with an intestinal obstruction (ileus) or an infarction of the intestinal vessels (mesenteric infarction).

In rare cases, tuberculosis can be the cause of peritonitis. In this case, the symptoms are more likely to appear as mild peritonitis. In so-called spontaneous bacterial peritonitis, the inflammation is often the result of an accumulation of fluid in the abdominal cavity ( ascites, abdominal dropsy).

In chemical irritation, a body fluid gets into the peritoneum and chemically irritates it. These fluids can be blood, bile or the contents of the stomach or intestines and can get into the peritoneum through perforation of the corresponding organ. This is often a ruptured gastric ulcer.

Peritonitis caused by metabolic products is a rare cause and is also often referred to as pseudoperitonitis. Examples of possible reasons are porphyrias, i.e. metabolic diseases in which blood precursors accumulate in the body, or diabetic ketoacidosis, in which ketone bodies are deposited.

Primary and secondary peritonitis

A distinction is made between the primary and the secondary forms of peritonitis, which differ in cause and course.

In primary peritonitis, there is initially no disease of the internal abdominal organs, and the pathogens migrate into the peritoneum via blood or lymph. This peritonitis is rarer and usually takes a chronic course, i.e. over a more extended period.

In secondary peritonitis, the cause is a pre-existing disease of the internal abdominal organs, such as appendicitis (also known as appendicitis, although strictly speaking only the appendix of the appendix is ​​inflamed), perforation of digestive organs, mesenteric ischemia (sudden undersupply of intestinal sections due to blocked vessels). ) or a deep abdominal injury. This form is more common than the primary one and progresses quickly, usually within a few hours. This course is also known as acute peritonitis.


Symptoms: How does peritonitis become noticeable?

How peritonitis manifests itself and where pain occurs also depends on whether it is primary or secondary. Both forms cause the same symptoms, but the course of the secondary form is usually much faster and more dangerous. The symptoms in women and men do not differ.

The symptoms of peritonitis are usually relatively typical. The most important sign is a so-called defensive tension in the abdomen. The abdominal wall is tight, and every touch leads to a muscular tension of the abdominal muscles. Since many nerves traverse the peritoneum, patients also complain of pain, especially when an organ has ruptured. In addition to severe abdominal pain, it can also lead to a bloated stomach, nausea and loss of appetite. Fever and a general feeling of illness are also possible signs.

Other symptoms can be circulatory instability and an intestinal obstruction, which manifests itself, among other things, in constipation. Back pain radiating from the abdomen can also be a symptom.

How is peritonitis diagnosed?

The diagnosis of peritonitis begins with the working diagnosis of “acute abdomen”. This expression describes the combination of severe, sudden abdominal pain, defensive tension and circulatory instability. Acute abdomen can have many causes; peritonitis is just one of them.

For the doctor to be able to diagnose “peritonitis”, the person concerned must first undergo a clinical examination. The typical symptoms, such as the particularly noticeable immune tension, are identified during the examination. Still, tumours or hernias (intestinal hernias such as an inguinal hernia ), which can also trigger an acute abdomen, can also be ruled out in this way. In addition, ultrasound or CT, for example, are available to identify the causes of peritonitis.

But the blood values, such as the CRP (C-reactive protein) or the haemoglobin value, can also provide information about a (bacterial) inflammation or blood loss, such as a perforation. Identifying the cause of peritonitis is essential, as the forms of therapy differ accordingly.

Therapy: How is peritonitis treated?

Since the causes of peritonitis are very diverse, so are the treatment options. In any case, the cause of the peritonitis should be eliminated first. Treatment often requires surgery. For example, if the cause is appendicitis, the appendix is ​​surgically removed. If a ruptured gastric ulcer causes peritonitis, the defect in the gastric mucosa is sewn up.

If intestinal contents or body fluids have already entered the abdominal cavity, the abdominal cavity, where the peritoneum is located, is rinsed with a so-called Ringer’s solution during the operation to remove impurities. At the same time as the operation, antibiotic therapy is given through the vein to fight bacterial pathogens or prevent the infection from worsening.

Rarer causes of peritonitis, such as tuberculosis or rheumatic diseases, are treated according to the respective disease; the treatment can be done with medication, for example.


How long do you have to stay in the hospital after peritonitis?

The length of hospital stay depends mainly on the cause. Primary, localized peritonitis heals faster, usually within a week. However, since peritonitis is a severe clinical picture in most cases, those affected with the disease usually stay in the hospital for weeks, often even in the intensive care unit.

How dangerous is peritonitis?

Peritonitis is usually a highly acute and life-threatening condition that must always be taken seriously. Therefore, quick cause clarification and therapy are crucial to avert a fatal course.

It can also lead to dangerous complications. These include:

  • sepsis (also known as blood poisoning) when the infection spreads through the bloodstream in the body
  • an intestinal paralysis (paralytic ileus)
  • mechanical intestinal obstruction caused by inflammation and adhesions of the intestine
  • a shock, for example, as a result of an intestinal blockage
  • the formation of abscesses in the abdomen or organs

Complications are more common in chronically ill or older adults.

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