Spontaneous bacterial peritonitis
- Bacterial infection of ascitic fluid in the absence of an intra-abdominal source of infection
- Most common in
- Infants and children
- Nephritic syndrome
- Adults with cirrhosis – poor phagocytosis causes poor control of bacterial load
- Patientss who undergo splenectomy
- Malnutrition and malignancy
- Patients with ascites due to any cause
Causative organisms
- G negative bacilli – E.coli, Klebsiella
- G postiive cocci – pneumococci, streptococci, enterococci
- Anaerobes
Clinical features
- Features of peritonitis but initially with dull aching pain
- Features of shock
- High fever with neutrophilia
- Diarrhoea
Management
- Antibiotics
- Drainage purulent fluid from peritoneal cavity
- Laparoscopy or laparotomy
Tuberculous peritonits
- Infection originates from TB in mesenteric lymph nodes or disseminates from pulmonary TB
Acute TB peritonitis
- Similar to acute peritonitis
- On laparotomy – straw coloured fluid and tubercles are seen on the peritoneum
Chronic TB peritonitis
- Abdominal pain, fever, weight loss, ascites, night sweats, abdominal mass
Sclerosing peritonitis
- Usually B-blocker induced peritonitis
- It is fibrinous peritonitis causing thickening of the bowel and other contents of the abdomen
- Leads to intestinal obstruction and malnutrition
Biliary peritonitis
Causes
- Trauma
- Post operative leak after surgery for gallbaldder, common bile duct, or leak from choledochojejunal anastomosis
Clinical features
- Features of peritonitis – abdominal distention, guarding, rigidity
- Jaundice
- Toxicity
- Features of shock
Investigations
- Abdominal XR
- Diagnostic peritoneal lavage
Treatment
- Laparotomy, wash, drainage
- US guided percutaneous drainage
- High mortality
Postoperative peritonitis
- Development of peritonitis in the post operative period due to anastomotic or biliary leak
- Leads to collection of pus in the peritoneal cavity
- Paralytic ileus is common in post operative patients for 3-5 days – however, if this persists for longer, post operative peritonitis should be suspected
- Other features suggestive of peritonitis
- Persisting toxaemia despite antibiotics
- Oliguria
- Fever
- Very high or very low WBC count
- Increasing leak from drain site
- Increasing abdominal distension, pain and tenderness
Investigations
- Immediate US/CT abdomen
- Assessment of urinary output, LFTs, blood urea and creatinine
Treatment
- Immediate exploration with wide exposure of the abdomen – to identify cause of infection
- Irrigation and drainage
- Antibiotics
- Ventilator support
Other types of peritonitis
- Meconium peritonitis
- Gonococcal peritonitis with perihepatitis – Curtis-Fitz-Hugh syndrome