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Synonyms and keywords: Acute bacterial peritonitis, acute generalized peritonitis, acute peritonitis, abscess of suppurative peritonitis, acute suppurative peritonitis, purulent peritonitis, subphrenic peritonitis, pelvic peritonitis, acute serositis, aseptic peritonitis, chronic peritonitis, continuous ambulatory peritoneal dialysis associated peritonitis, fungal peritonitis, granulomatous peritonitis, peritoneal dialysis-associated peritonitis, serositis, chemical peritonitis, neonatal peritonitis, tuberculous peritonitis, peritoneal abscess, spontaneous bacterial peritonitis, benign paroxysmal peritonitis, pyogranulomatous serositis, perforation peritonitis, CAPD peritonitis, primary peritonitis, secondary peritonitis, tertiary peritonitis.

# Definition
Peritonitis is defined as inflammation of the peritoneum (a tissue that lines the inner wall of the abdominal cavity and covers most of the abdominal organs) from any cause. In contrast to peritonitis intrabdominal infection is defined as inflammation of peritoneum due to an infectious cause.
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
Causes of peritonitis can be divided into infected and non-infected, which are as follows:

## Risk factors for Secondary peritonitis

## Causes of Non-Infected Peritonitis

## Classification Based on the clinical view point
Peritonitis may be classified based on the prognosis into the following types:
- Uncomplicated: In uncomplicated peritonitis, the infection only involves a single organ and no anatomical disruption is present. Usually, patients with such infections can be managed with surgical resection alone and no antimicrobial therapy besides peri-operative prophylaxis is necessary.
- Complicated:The infectious process proceeds beyond the organ that is the source of the infection, and causes either localised peritonitis, also referred to as abdominal abscess, or diffuse peritonitis, depending on the ability of the host to contain the process within a part of the abdominal cavity.They are the important cause of morbidity and more frequently associated with poor prognosis.However, an early clinical diagnosis, followed by adequate source control to stop ongoing contamination and restore anatomical structures and physiological function, as well as prompt initiation of appropriate empirical therapy, can limit the associated mortality.

## Classification based on the etiological agents
- Peritonitis, caused by enteric organisms such as E.coli, Klebsiella, staphylococci, streptococci, anaerobes.
- Peritonitis, caused by bacteria residing out of GI tract such as gonococci, pneumococci.
- Aseptic peritonitis resulting from irritation of the peritoneal cavity from the extravasation of fluids such as blood, gastric juice.

## Classification based on the pathological alterations in the clinical course of peritonitis
- Reactive: In the first 24 hours when there are maximal manifestations of local signs of peritonitis.
- Toxic: In 24-72 hours, when there is increased general intoxication with a gradual reduction in the local signs of peritonitis.
- Terminal: It is often the severe stage of peritonitis, usually after 72 hours characterized by irreversible intoxication in the background of a sharply expressed local manifestations of peritonitis.

## Pathophysiology
Peritonitis results from contamination of normal sterile peritoneal cavity with infections or chemical irritants. Release of bile or gastric juices initially causes chemical peritonitis, infection occurs when bacteria enter and contaminate the peritoneal cavity. Bacterial peritonitis is usually caused by normal enteric flora like E.coli, Klebsiella. Inflammatory process causes shift of fluid into the peritoneal cavity(third spacing) which leads to hypovolemia, septicemia and multi-organ failure resulting in death of the patient if not adequately diagnosed and treated early.
- The main causes of peritonitis are the acute inflammation of the abdominal viscera, discontinuity and increased permeability of their walls, open and closed traumas of the abdomen with the damage of viscera followed by microbial contamination of peritoneal cavity.
- Despite the cause of peritonitis, the disease is characterized by a typical bacterial inflammation.
- Chronic peritonitis is caused mainly by extraperitoneal (lungs, lymph nodes) tuberculosis, entering the peritoneal cavity through hematogenous route.

## Causes in Alphabetical Order
- 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

## Differential Diagnosis

# Differential Diagnosis

# Natural history, complications and prognosis of peritonitis
The stronger predictors of poor outcome both in SBP and secondary BP patients include the concurrent development of sepsis and subsequent multiple organ failure (MOF). Sepsis may progress to conditions of varying severity. There is an increased risk of death along transition from sepsis to severe sepsis and septic shock. With insufficient treatment, sepsis may cause functional impairment of one or more organs or systems and finally lead to MOF. There is a strong correlation between mortality rate and number of failing organs. Several scoring systems have been developed to assess the clinical prognosis of patients with bacterial peritonitis. The most widely used include the APACHE-II, Mannheim Peritonitis Index (MPI), the Multiple Organ Dysfunction Score (MODS), and the Sepsis-related Organ Failure Assessment (SOFA) score. Most of the scores are based on host criteria, systemic signs of sepsis, and complications related to organ failure but these scores have limited significance in the specific, day-to-day clinical decision-making process for each individual patient.
-  Blot S, De Waele JJ (2005). "Critical issues in the clinical management of complicated intra-abdominal infections". Drugs. 65 (12): 161120. PMID 16060697..mw-parser-output cite.citation{font-style:inherit}.mw-parser-output q{quotes:"\"""\"""'""'"}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-lock-free a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-limited a,.mw-parser-output .cs1-lock-registration a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-subscription a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{display:none;font-size:100%}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}