Peritonitis

Clinical Manifestations

Primary peritonitis

• See Spontaneous bacterial peritonitis

Secondary peritonitis

• Secondary to surgery, trauma, or perforation

Tertiary peritonitis

• Ongoing intraabdominal sepsis after appropriate treatment of secondary peritonitis
• Organisms include resistant Gram-positives (Enterococcus, coagulase-negative staphylococci), resistant Gram-negative bacilli (ESBLs), and Candida
• Can also be aseptic without infection but with ongoing inflammation

Peritoneal dialysis-related peritonitis

• See peritoneal dialysis-associated peritonitis

Differential Diagnosis

• Appendicitis
• Pneumonia
• Diabetic ketoacidosis
• Porphyria
• Familial Mediterranean fever
• Systemic lupus erythematosus
• Uremia

Management

• Primary: see spontaneous bacterial peritonitis management
• Secondary:
  • Source control
  • Broad-spectrum antibiotics
  • See also STOP IT trial for 4+/-1 days of antibiotics after source control1
• Associated with peritoneal dialysis: see peritoneal dialysis-associated peritonitis