Peritonitis

Dr. Sulaiman Bin Yusof

MbChB (Sheffield) M.Med (Surg) FRCSEd (Gen Surg)
蘇萊曼·尤索夫博士

Peritonitis is an inflammation of the peritoneum, a thin layer of tissue that lines the inner abdominal wall and covers most abdominal organs.

It is a serious condition that usually occurs due to infection, which can result from a perforation (hole) in the digestive tract, injury, or medical procedures. Peritonitis requires urgent medical attention as the infection can rapidly spread to the bloodstream, potentially leading to sepsis, a life-threatening complication.

Symptoms of Peritonitis

Symptoms of peritonitis often develop suddenly and can worsen quickly. Common symptoms include:

Severe Abdominal Pain

Inflammation in the peritoneum causes intense, widespread abdominal pain. Movement often worsens the pain as it stretches or shifts the inflamed tissue. The abdominal muscles may also tense, creating a “rigid” or hard abdomen.

Swelling and Tenderness

The inflammation from peritonitis often causes fluid to build up in the abdominal cavity, leading to visible swelling. The affected area becomes extremely tender, making the abdomen sensitive to touch or pressure.

Fever and Chills

The immune system’s response to infection causes fever and chills, which are part of the body’s efforts to fight off bacteria.

Nausea and Vomiting

Peritoneal inflammation can disrupt digestion, resulting in nausea and vomiting. It affects the surrounding organs, causing digestive upset and slowing food movement through the intestines, both of which contribute to nausea.

Loss of Appetite

Appetite loss is common due to abdominal pain, nausea, and overall digestive disruption. The body may naturally avoid eating to relieve digestive strain on already irritated and inflamed tissues.

Rapid Heartbeat and Breathing

The body’s response to infection and inflammation stresses the system, resulting in a faster heartbeat and breathing. These may also indicate early signs of sepsis, where infection spreads to the bloodstream.

Confusion or Fatigue

A severe infection can affect overall body function, causing fatigue and confusion. This is especially common if the infection has started affecting multiple systems, signalling potential sepsis.

Causes and Risk Factors

Peritonitis generally results from bacterial infection, with common causes including:

Perforation in the Abdomen: A hole in the digestive tract, often caused by conditions like a ruptured appendix, stomach ulcer, or diverticulitis, can release bacteria into the abdominal cavity, causing peritonitis. These conditions heighten the risk of perforation.

Medical Procedures: Procedures like abdominal surgery or peritoneal dialysis (a treatment for kidney failure) can introduce bacteria into the abdominal cavity. Patients undergoing peritoneal dialysis have a higher infection risk, requiring careful hygiene practices.

Liver Disease Complications: Chronic liver conditions like cirrhosis can lead to fluid build-up (ascites) in the abdomen, increasing infection risk. This can lead to spontaneous bacterial peritonitis (SBP), where infection occurs without any rupture or injury.

Diagnosing Peritonitis

Diagnosing peritonitis typically involves a physical exam and a combination of tests to confirm infection and identify the source.

Physical Examination

During a physical exam, the doctor will press on different areas of the abdomen to check for tenderness, swelling, or a hard “board-like” feel, which can indicate inflammation. Increased pain when pressure is applied and released (rebound tenderness) is a common indicator of peritonitis and can aid in the diagnosis.

Blood Tests

Blood tests can reveal elevated white blood cell counts, which indicate that the body is responding to an infection. These tests can also help identify the specific bacteria causing the infection, which can guide treatment decisions.

Imaging Tests

CT scans or X-rays provide detailed images of the abdomen, helping detect any perforations or abnormal fluid accumulation that may be causing or resulting from peritonitis. These imaging methods can also reveal other potential issues, such as abscesses or blockages, which may require surgical intervention.

Peritoneal Fluid Analysis

If fluid is present in the abdominal cavity (ascites), a sample may be collected with a needle through a procedure called paracentesis. This fluid is tested for the presence of bacteria and high white blood cell counts, which confirm infection and help pinpoint the type of bacteria involved.

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Treatment Options for Peritonitis

Non-Surgical Treatment and Supportive Care

In cases where peritonitis is not caused by a perforation, non-surgical treatment is often appropriate, and hospitalisation is typically required for close monitoring.

Antibiotics

Treatment usually begins with intravenous (IV) antibiotics administered directly into the bloodstream to rapidly target and control the infection. The specific antibiotic regimen may be modified based on lab results to ensure effective treatment of the identified bacteria.

Supportive Care

In addition to antibiotics, supportive care helps manage symptoms and maintain stability during recovery. This includes IV fluids to prevent dehydration and balance electrolytes, pain medications to relieve discomfort, and anti-nausea medications to control digestive upset. Regular monitoring of vital signs, such as heart rate and blood pressure, is also necessary to detect early signs of complications, such as sepsis.

Surgical Treatment

If peritonitis is due to a perforation or blockage, surgery is usually necessary.

Laparoscopic Surgery

For less severe cases, laparoscopic surgery, a minimally invasive procedure, may be used. This method involves making small incisions in the abdomen, through which a camera and surgical instruments are inserted to locate and repair the perforation. Laparoscopic surgery generally involves less pain and scarring, with shorter recovery times than open surgery.

Laparotomy (Open Surgery)

In severe cases, a laparotomy (open surgery) may be needed. The surgeon makes a large incision to access and repair the infection source, such as a tear in the intestine. They thoroughly clean the abdominal cavity to remove infected tissue or contaminants, ensuring a more extensive infection treatment.

Abscess Drainage

Abscesses (pockets of pus) that form in the abdomen as a result of infection must be drained to prevent further spread. Drainage can be performed during surgery or using a small tube inserted into the abscess with imaging guidance. This procedure helps to clear the infection and support recovery, as untreated abscesses can lead to further complications.

Preventing Peritonitis

Preventing peritonitis involves measures to reduce infection risk, especially for high-risk individuals. Patients on peritoneal dialysis should practice strict hygiene, including careful catheter cleaning and handling equipment with clean hands. Prompt treatment of digestive issues, such as appendicitis or stomach ulcers, can also help prevent rupture-related infections.

For those with liver disease, regular check-ups to monitor for fluid build-up (ascites) are necessary, and preventive antibiotics may be recommended to reduce infection risk.

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Dr. Sulaiman Bin Yusof

MbChB (Sheffield)

M.Med (Surgery)

FRCSEd (General Surgery)

蘇萊曼·尤索夫博士

Dr. Sulaiman Yusof is a distinguished Senior Consultant in colorectal and general surgery, boasting over 15 years of expertise. His passion lies in minimally invasive techniques, particularly robotic surgery, where he has achieved remarkable success using the Da Vinci Xi system. Dr. Sulaiman is dedicated to delivering high-quality, personalized, and empathetic care, always striving for the best outcomes for his patients.

Education & Specialist Training
  • MbChB(Sheffield)
  • M.Med(Surgery)
  • FRCSEd(General Surgery)

Dr. Sulaiman’s journey began at the University of Sheffield, where he graduated in 2002. He honed his skills during his house officer and basic surgical training in the UK before returning to Singapore. There, he completed his Advanced Surgical Training at Changi General Hospital and earned the Joint Speciality Fellowship in General Surgery in 2013.

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    Frequently Asked Questions

    How long does it take to recover from peritonitis?

    Recovery time varies based on infection severity and treatment. Hospitalisation may last several days to weeks, and full recovery may take additional weeks or months after discharge, often with follow-up care.

    Can peritonitis come back after treatment?

    Yes, peritonitis can recur, especially in individuals with risk factors like liver disease or those on peritoneal dialysis. Regular monitoring and preventive care are necessary to reduce the risk of recurrence.

    Are there long-term effects after recovering from peritonitis?

    Most people recover fully, but some may experience mild digestive issues or abdominal discomfort during recovery. In severe cases, scar tissue or adhesions (bands of tissue) may form in the abdomen, which can cause persistent discomfort or digestive issues.

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