Peritonitis

doctor img
Dr Chong Choon Seng

MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)

Peritonitis is an inflammation of the peritoneum, the thin layer of tissue that lines the inner abdominal wall and covers the organs within the abdomen. This condition triggers an inflammatory response that can lead to severe complications, including sepsis and organ failure. Without prompt medical intervention, peritonitis can become life-threatening as bacteria and other harmful substances spread throughout the abdominal cavity.

Symptoms of Peritonitis Symptoms of Peritonitis

Symptoms of Peritonitis

The body responds to peritoneal inflammation through several distinct manifestations:

  • Abdominal Pain: Severe, constant pain spreads across the abdomen, worsening with any movement or touch.
  • Abdominal Distension: The belly becomes swollen and taut due to fluid accumulation and bowel inflammation.
  • Fever and Chills: Body temperature rises above 38°C, often accompanied by uncontrollable shivering.
  • Reduced Urine Output: Urine production decreases as fluid shifts into the abdominal cavity.
  • Nausea and Vomiting: The inflammatory process affects digestive function, leading to persistent nausea and vomiting.
  • Rapid Heart Rate: The heart beats faster than normal as the body responds to inflammation and infection.

Causes and Risk Factors

Peritonitis can arise from various medical conditions and circumstances that allow infection or irritation of the peritoneal cavity. These include:

Gastrointestinal Perforation

A perforation in the digestive tract can occur due to conditions such as peptic ulcers, diverticulitis, or traumatic injury from fishbone. This allows digestive contents, including bacteria, to escape into the sterile peritoneal cavity, triggering inflammation and infection.

Ruptured Appendix

Advanced appendicitis can lead to the rupture of the appendix. When this occurs, infected material from the appendix spills into the abdominal cavity, causing widespread inflammation and potentially severe infection.

Peritoneal Dialysis

Individuals undergoing long-term peritoneal dialysis for kidney failure face an increased risk of peritoneal inflammation. Frequent access to the peritoneal cavity through catheters can introduce bacteria or other pathogens, leading to infection.

Cholecystitis

Bacterial infection of the gallbladder, usually caused by gallstones, can result in the inflammation of the surrounding peritoneum on the right upper part of the abdomen. This can be a potential surgical emergency as the gallbladder may perforate and cause bilious fluid to flow outside of the intestine. This will result in the intense pain in the abdomen.

Pancreatitis

Severe inflammation of the pancreas, often due to gallstones or excessive alcohol consumption, can cause the release of digestive enzymes into the abdominal cavity. These enzymes irritate the peritoneum, causing inflammation and sometimes secondary infection.

Abdominal Surgery

Recent surgical interventions in the abdominal region can compromise the integrity of the peritoneum. Surgical procedures involving the gastrointestinal tract, in particular, can lead to complications such as anastomotic leaks and peritonitis.

Diagnosis of Peritonitis

Physical Examination

The doctor checks for abdominal tenderness, rigidity, and rebound tenderness. These signs help determine the severity and location of inflammation. The examination includes vital sign measurements and an overall health assessment.

Blood Tests

Laboratory analysis measures white blood cell count, inflammatory markers, and organ function. The tests also identify bacterial infections and assess the body’s response to infection.

Paracentesis

Fluid from the abdominal cavity can be drawn for laboratory analysis. This procedure identifies specific bacteria and helps determine appropriate antibiotic therapy and is included mainly for peritonitis resulting from an infected peritoneal dialysis catheter.

Imaging Studies

CT scans and ultrasounds reveal free fluid in the abdomen, organ perforation, or other anatomical abnormalities. These images guide treatment planning and surgical intervention when needed.

Treatment Options

Managing peritonitis involves prompt medical intervention, with treatment tailored to the severity and underlying cause. Approaches include non-surgical and surgical options:

Non-Surgical Treatment

  • Antibiotics: Treatment for peritonitis typically begins with antibiotics administered intravenously to combat the infection promptly. These antibiotics are adjusted once laboratory results identify the specific pathogen, ensuring a more targeted approach. Regular blood tests are conducted to monitor the effectiveness of the antibiotics and detect any complications, guiding further adjustments to the treatment plan.
  • Fluid and Electrolyte Management: Peritonitis often leads to dehydration and imbalances in electrolyte levels, which can affect vital organ function. Intravenous fluids are provided to stabilise blood volume, maintain blood pressure, and restore electrolyte balance. Continuous monitoring ensures fluid levels are optimised to support recovery and prevent complications such as kidney dysfunction or cardiovascular instability.
  • Pain Management: Effective pain relief is required to improve patient comfort while ensuring that symptoms required for further evaluation are not masked. A carefully chosen combination of medications is used, with doses adjusted according to the patient’s response and recovery progress. This approach balances pain control with maintaining awareness for signs of worsening or resolving infection.

Surgical Treatment

  • Drainage of Infected Material: In cases involving abscesses or significant contamination in the abdominal cavity, surgical or percutaneous drainage is usually required. This process involves the removal of pus, infected fluid, and removal of the source to reduce the risk of further infection and promote healing. Temporary drainage systems may be installed to manage post-surgical fluid accumulation and prevent recurrence.
  • Laparoscopic Surgery: Laparoscopic surgery is a preferred option for treating peritonitis when surgical intervention is required. This minimally invasive technique uses small incisions and specialised instruments to repair perforations, remove infected tissue, or clean the abdominal cavity. It reduces recovery time, minimises pain, and lowers the risk of wound infections compared to open surgery, making it especially suitable for patients with mild to moderate peritonitis or those at higher risk from invasive procedures.
  • Laparotomy (Open Surgery): Laparotomy is performed in severe or complex cases of peritonitis where minimally invasive methods are insufficient. It involves a large abdominal incision, allowing thorough exploration, removal of infected tissue, repair of perforations, and cleaning of contaminated areas. Though recovery is longer and infection risk is higher compared to laparoscopic surgery, it is necessary for managing life-threatening conditions.

Are Your Symptoms Affecting Your Quality of Life?

Consult our MOH-accredited specialist for an accurate diagnosis & personalised treatment plan today.

image

Prevention and Management

Prevention focuses on prompt treatment of conditions that can lead to peritonitis. Individuals with peritoneal dialysis must maintain strict hygiene protocols during catheter care. Regular medical check-ups help detect and treat potential causes early. Those with chronic conditions affecting the digestive system should follow their prescribed treatment plans carefully. After recovery, patients need regular follow-up appointments to monitor for recurrence and complications.

Frequently Asked Questions

Can peritonitis return after successful treatment?

Yes, recurrence is possible, especially in individuals with ongoing risk factors such as peritoneal dialysis, chronic bowel conditions, or weakened immunity. Implementing preventive measures, such as maintaining catheter hygiene or managing underlying conditions, and regular medical monitoring can significantly reduce the likelihood of recurrence.

When should patients seek emergency care after treatment?

Patients should seek immediate medical attention if they experience symptoms like renewed abdominal pain, fever, nausea, vomiting, or reduced urine output after completing treatment. These signs may indicate a recurrence or complications requiring urgent evaluation and intervention.

How does peritonitis affect long-term health?

Peritonitis can lead to long-term issues such as abdominal adhesions (scar tissue), which may cause pain, bowel obstruction, or changes in bowel function. Regular follow-up care is necessary for monitoring these potential complications, addressing symptoms early, and supporting overall recovery.

Partnered Programmes & Insurance Plans

For Singaporeans, Singapore Permanent Residents and Foreigners. Please speak to our friendly clinic staff about using your insurance plans.

image

Dr Chong Choon Seng

MBBS (NUS)

MRCS (Edinburgh)

Masters in Medicine (Surgery)(NUS)

FRCS (Edinburgh)

Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.

As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.

contact us

Please leave us a message and our friendly clinic staff will get back to you as soon as possible. For urgent or same day appointments, kindly call the clinic to arrange an appointment.

    Our Clinic Locations

    Ark Surgical Practice – Mouth Elizabeth Medical Centre

    3 Mount Elizabeth, #17-01
    Singapore 228510

    Monday to Friday: 9am – 5pm
    Saturday: 9am – 12:30pm
    Sunday & Public Holidays: Closed

    Ark Surgical Practice – Mount Elizabeth Novena Hospital

    38 Irrawaddy Road, #09-34
    Singapore 329563

    Monday to Friday: 9am – 5pm
    Saturday: 9am – 12:30pm
    Sunday & Public Holidays: Closed

    +65‎ 8900‎ 6111