Peritonitis causes

Peritonitis Main Page

Patient Information

Overview

Causes

Classification

Spontaneous Bacterial Peritonitis
Secondary Peritonitis

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2] Shivani Chaparala M.B.B.S [3]

## Overview[edit | edit source]

The most common cause of peritonitis is perforation of a hollow viscus such as perforation of the distal esophagus (Boerhaave syndrome), of the stomach (peptic ulcer, gastric carcinoma), of the duodenum (peptic ulcer), of the remaining intestine (e.g. appendicitis, diverticulitis, Meckel's diverticulum, IBD, intestinal infarction, intestinal strangulation, colorectal carcinoma, meconium peritonitis), or of the gallbladder (cholecystitis). Other causes of infected peritonitis include spontaneous bacterial peritonitis and disruption of the peritoneum, such as in cases of trauma, surgical wounds, continuous peritoneal dialysis, and intra-peritoneal chemotherapy. Causes of non-infected peritonitis include endometriosis, blunt abdominal trauma, gastric carcinoma, peptic ulcer, pelvic trauma, and pancreatitis.

## Causes[edit | edit source]

Causes of peritonitis can be divided into infected and non-infected, which are as follows:

### Causes of Infected Peritonitis[edit | edit source]

Perforation of a hollow viscus organ  | Disruption of the peritoneum  | Spontaneous bacterial peritonitis (SBP)  | Systemic infections

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Perforation of a hollow viscus (most common cause of peritonitis)

* Perforation of the distal esophagus (Boerhaave syndrome)

* Perforation of the stomach (peptic ulcer, Gastric carcinoma)

* Perforation of the duodenum (peptic ulcer)

* Perforations of the remaining intestine (e.g. Appendicitis, Diverticulitis, Meckel diverticulum, IBD, Intestinal infarction, Intestinal strangulation, Colorectal carcinoma, Meconium peritonitis)

* Perforation of the gallbladder (cholecystitis)

Other possible causes for perforation

* Trauma

* Ingestion of a sharp foreign body (such as a fish bone)

* Perforation by an endoscope or catheter

Most common organisms -mixed bacteria

* Gram-negative bacilli (e.g. Escherichia coli), Anaerobic bacteria (e.g. Bacteroides fragilis)

* Trauma

* Surgical wound

* Peritoneal dialysis

* Chemotherapy

Most common organisms

* Mixed bacteria

* Staphylococcus aureus

* Coagulase-negative staphylococci

* Fungi such as Candida

Peritonitis occurring in the absence of an obvious source of contamination. It occurs either in children, or in patients with ascites.

e.g. Tuberculosis

### Causes of Non-Infected Peritonitis[edit | edit source]

Leakage of sterile body fluids into the peritoneum  | Sterile abdominal surgery  | Rarer non-infectious causes

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Sterile body fluids such as

* Blood(e.g.Endometriosis, Blunt abdominal trauma),
* Gastric juice (e.g.Peptic ulcer, Gastric carcinoma),
* Bile (e.g. Liver biopsy),
* Urine (e.g. Pelvic trauma),
* Menstruum (e.g. salpingitis),
* Pancreatic juice (pancreatitis),

These body fluids are sterile at first, they frequently become infected once they leak out of their organ, leading to infectious peritonitis within 24-48h.

Due to sterile foreign body inadvertently left in the abdomen after surgery (e.g. gauze, sponge)

* Familial Mediterranean fever
* Porphyria
* Systemic lupus erythematosus

### Causes by Organ System[edit | edit source]

Cardiovascular | No underlying causes

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Chemical/Poisoning | No underlying causes
Dental | No underlying causes
Dermatologic | No underlying causes
Drug Side Effect | No underlying causes
Ear Nose Throat | No underlying causes
Endocrine | No underlying causes
Environmental | No underlying causes
Gastroenterologic | Appendicitis, Ascites, Boerhaave syndrome, Cholecystitis, Cholelithiasis, Chronic liver disease, Diverticulitis, Gall bladder rupture, Gastrointestinal perforation, IBD, Intestinal strangulation, Mallory-Weiss syndrome, Meckel diverticulitis, Meconium peritonitis, Neonatal necrotizing enterocolitis, Pancreatitis, Peptic ulcer, Perihepatitis, Recurrent hereditary polyserositis, Toxic megacolon, Typhlitis
Genetic | No underlying causes
Hematologic | No underlying causes
Iatrogenic | Continuous ambulatory peritoneal dialysis, Intra-peritoneal chemotherapy, Surgical wounds
Infectious Disease | Bacteroides fragilis, E. coli, Enterobacteriaceae, Escherichia coli, Fitz-Hugh Curtis syndrome, Klebsiella pneumoniae, Pseudomonas, Staphylococcus, Streptococcus pneumoniae, Streptococcus pyogenes, Miliary tuberculosis
Musculoskeletal/Orthopedic | No underlying causes
Neurologic | No underlying causes
Nutritional/Metabolic | No underlying causes
Obstetric/Gynecologic | Endometriosis, Fitz-Hugh Curtis syndrome, Pelvic inflammatory disease
Oncologic | Colorectal carcinoma
Ophthalmologic | No underlying causes
Overdose/Toxicity | No underlying causes
Psychiatric | No underlying causes
Pulmonary | No underlying causes
Renal/Electrolyte | Nephritic syndrome
Rheumatology/Immunology/Allergy | Systemic lupus erythematosus
Sexual | No underlying causes
Trauma | Trauma
Urologic | No underlying causes
Miscellaneous | Ruptured dermoid cyst, Spontaneous bacterial peritonitis

### Causes in Alphabetical Order[edit | edit source]

* Appendicitis
* Ascites
* Bacteroides fragilis
* Boerhaave syndrome
* Cholecystitis
* Cholelithiasis
* Chronic liver disease
* Colorectal carcinoma
* Continuous ambulatory peritoneal dialysis
* Diverticulitis
* Endometriosis
* Enterobacteriaceae
* Escherichia coli
* Fitz-Hugh Curtis syndrome
* Gall bladder rupture
* Gastrointestinal perforation
* IBD
* Intestinal strangulation
* Intra-peritoneal chemotherapy
* Klebsiella pneumoniae
* Mallory-Weiss syndrome
* Meckel diverticulitis
* Meconium peritonitis
* Muckle-Wells syndrome
* Neonatal necrotizing enterocolitis
* Nephritic syndrome
* Pancreatitis
* Pelvic inflammatory disease
* Peptic ulcer
* Perihepatitis
* Peritoneal dialysis
* Pseudomonas
* Recurrent hereditary polyserositis
* Ruptured dermoid cyst
* Spontaneous bacterial peritonitis
* Staphylococcus
* Streptococcus milleri
* Streptococcus pneumoniae
* Streptococcus pyogenes
* Surgical wounds
* Systemic lupus erythematosus
* Toxic megacolon
* Trauma
* Typhlitis
* Tuberculosis

## References[edit | edit source]

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