Peritonitis is an inflammation of the peritoneum, the thin membrane that lines the abdominal wall and covers the organs inside. It is caused by a bacterial or fungal infection.
There are two major types of peritonitis. Primary peritonitis happens when an infection spreads from the blood and lymph nodes to the peritoneum. This type of peritonitis is rare, less than 1% of all cases.
The more common type of peritonitis, called secondary peritonitis, happens when the infection comes into the peritoneum through a perforation in the abdominal wall.
Both cases of peritonitis are very serious and can be life threatening if not treated quickly.
Signs and Symptoms
The signs and symptoms of peritonitis include:
- Swelling and tenderness in the abdomen with pain ranging from dull aches to severe, sharp pain
- Fever and chills
- Loss of appetite
- Nausea and vomiting
- Less urine
- Not being able to pass gas or stool
Primary peritonitis is usually caused by a liver disease. Fluid builds up in the abdomen, creating an environment for bacteria to grow.
Secondary peritonitis is caused by other conditions that allow bacteria or fungus to come into the peritoneum from a hole or tear in the abdominal wall. Tears can be caused by:
- A ruptured appendix
- A stomach ulcer
- Crohn disease
Peritoneal dialysis, which uses the blood vessels in the abdomen to filter waste from your blood when your kidneys cannot, also may cause peritonitis.
The following factors may increase the risk for primary peritonitis:
- Liver disease (cirrhosis)
- Fluid in the abdomen
- Weakened immune system
- Pelvic inflammatory disease
Risk factors for secondary peritonitis include:
- Appendicitis (inflammation of the appendix)
- Stomach ulcers
- Torn or twisted intestine
- Inflammatory bowel disease, such as Crohn disease or ulcerative colitis
- Injury caused by an operation
- Peritoneal dialysis
Peritonitis is an emergency and can be life threatening. Your doctor will do a physical examination to see whether you need surgery to fix the underlying problem. The doctor will feel and press your abdomen to find any swelling and tenderness, and look for signs that fluid has collected in the area. The doctor may listen to bowel sounds and check for:
- Difficulty breathing
- Low blood pressure
- Signs of dehydration
The following procedures also may be performed:
- Blood tests, to see if there is bacteria in your blood
- Test samples of fluid from the abdomen, to identify the bacteria causing the infection
- CT scan, to identify fluid in the abdomen, or an infected organ
- X-rays, to spot air in the abdomen, which means that an organ may be torn or perforated
To prevent serious complications from peritonitis, get medical help as soon as symptoms appear. If you are getting peritoneal dialysis, you can help avoid peritonitis by cleaning the area around the catheter with antiseptic and washing your hands before touching the catheter.
If you have symptoms of peritonitis, seek medical help immediately. You will likely need to stay in the hospital for treatment. You may need surgery to get rid of the source of infection, such as an inflamed appendix, or to repair a tear in the abdominal wall. Your doctor will prescribe antibiotics to control infection. You may use complementary therapies along with conventional medicine when you are recovering from peritonitis.
Your doctor will prescribe antibiotics to kill bacteria and keep the infection from spreading. Other medications depend on the type of peritonitis and what is causing the condition.
Surgery and Other Procedures
People with peritonitis often need surgery to remove infected tissue and fix damaged organs.
Nutrition and Dietary Supplements
Peritonitis is a medical emergency and should be treated by a medical doctor. DO NOT try to treat peritonitis with herbs or supplements.
When you are recovering, a comprehensive treatment plan may include complementary and alternative therapies. Ask your team of health care providers how to include these therapies in your overall treatment plan. Always tell your provider about the herbs and supplements you are using or considering using.
The following nutrition habits may help you recover from any serious illness:
- Eat antioxidant-rich foods, including fruits (blueberries, cherries, and tomatoes) and vegetables (squash and bell peppers).
- Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (spinach and kale), and sea vegetables.
- Avoid refined foods, such as white breads, pastas, and especially sugar.
- Use healthy oils in foods, such as olive oil or vegetable oil.
- Avoid caffeine, alcohol, and tobacco.
- Drink 6 to 8 glasses of filtered water daily.
- Ask your doctor about taking a multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
- Probiotic supplement (containing Lactobacillus acidophilus among other species): 5 to 10 billion CFUs (colony forming units) a day, for gastrointestinal and immune health. Probiotics can help when you are taking antibiotics, because they can help restore the balance of "good" bacteria in the intestines. People with autoimmune diseases, such as lupus or rheumatoid arthritis, or people with weakened immune systems should ask their doctor before taking probiotics.
You may use herbs when you are recovering from peritonitis, but you should never use herbs to treat peritonitis. Ask your doctor before taking any herbs or supplements while you are recovering.
You may use homeopathy when you are recovering from peritonitis, but DO NOT use homeopathy alone to treat peritonitis. Peritonitis is a medical emergency. Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for peritonitis based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the right remedy.
- Belladonna: for people who are hypersensitive to touch, have sudden attacks of pain that come and go, and have a high fever
- Arsenicum album: for people with a swollen abdomen, unquenchable thirst, extreme chills, and symptoms that worsen at night
Prognosis and Complications
Complications from peritonitis can include:
- Sepsis: an infection throughout the blood and body that can cause shock, multiple organ failure, and death
- Abnormal clotting of the blood: often due to widespread infection
- Scar tissue in the peritoneum
- Acute respiratory distress syndrome: a severe infection of the lungs
The prognosis for peritonitis depends on the type of the condition. The outlook for people with secondary peritonitis tends to be poor, especially among:
- The elderly
- People with weakened immune systems
- Those who have had symptoms for longer than 48 hours before treatment
The long-term outlook for people with primary peritonitis due to liver disease also tends to be poor. However, the prognosis for primary peritonitis among children is usually very good after treatment with antibiotics.
Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol. 2006;100(4):1164-70.
Bennett: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders. 2014.
Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.
Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-50.
Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-75.
Ferri: Ferri's Clinical Advisor 2015. 1st ed. Philadelphia, PA: Elsevier Mosby. 2014.
Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistry. 2005;66(1):89-98.
Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.
Johnson DW, Clark C, Isbel NM, Hawley CM, Beller E, Cass A, de Zoysa J, McTaggart S, Playford G, Rosser B, Thompson C, Snelling P; HONEYPOT Study Group. The honeypot study protocol: a randomized controlled trial of exit-site application of medihoney antibacterial wound gel for the prevention of catheter-associated infections in peritoneal dialysis patients. Perit Dial Int. 2009 May-Jun;29(3):303-9.
LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH:LexiComp; 2000: 452-454.
Long: Principles and Practice of Pediatric Infectious Diseases, 4th ed. Philadelphia, PA: Elsevier Saunders. 2012.
Min YW, Lim KS, Min BH, et al. Proton pump inhibitor use significantly increases the risk of spontaneous bacterial peritonitis in 1965 patients with cirrhosis and ascites: a propensity score matched cohort study. Aliment Pharmacol Ther. 2014; 40(6):695-704.
Morris AM, Regenbogen SE, Hardiman KM, Hendren S. Sigmoid diverticulitis: a systemic review. JAMA. 2014; 311(3):287-97.
Piraino B. Insights on peritoneal dialysis-related infections. Contrib Nephrol. 2009;163:161-8.
Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.
Singal AK, Salameh H, Kamath PS. Prevalence and in-hospital mortality trends of infections among patients with cirrhosis: a nationwide study of hospitalised patients in the United States. Aliment Pharmacol Ther. 2014; 40(1):105-12.
Singer P, Shapiro H, Theilla M, Anbar R, Singer J, Cohen J. Anti-inflammatory properties of omega-3 fatty acids in critical illness: novel mechanisms and an integrative perspective. Intensive Care Med. 2008 Sep;34(9):1580-92.
Tok D, Ilkgul O, Bengmark S, Aydede H, Erhan Y, Taneli F, et al. Pretreatment with pro- and synbiotics reduces peritonitis-induced acute lung injury in rats. J Trauma. 2007 Apr;62(4):880-5.
Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-19.
Yeh SL, Lai YN, Shang HF, Lin MT, Chiu WC, Chen WJ. Effects of glutamine supplementation on splenocyte cytokine mRNA expression in rats with septic peritonitis. World J Gastroenterol. 2005 Mar 28;11(12):1742-6.
Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.
Yue GG, Fung KP, Tse GM, Leung PC, Lau CB. Comparative studies of various ganoderma species and their different parts with regard to their antitumor and immunomodulating activities in vitro. J Altern Complement Med. 2006 Oct;12(8):777-89.
Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.