Meconium peritonitis can occur from perforation of the bowel in utero. Ascites, secondary to cirrhosis of the liver, may become infected spontaneously. The symptoms of peritonitis depend on the virulence and extent of the infection. In a previously well patient, the sudden onset of abdominal pain is either localized, if the process is confined by viscera or omentum, or generalized, if the entire peritoneal cavity is involved. In severe cases of generalized peritonitis, tenderness occurs over the entire abdomen with vomiting and high fever.
Peristalsis is absent.
If peritonitis is not treated promptly and effectively, multisystem failure occurs rapidly. The loss of fluids into the peritoneal cavity and bowel leads to severe dehydration and electrolyte disturbances. The patient's face becomes drawn into the masklike appearance typical of hippocratic facies, and death follows within days. Adult respiratory distress syndrome also develops rapidly. Kidney failure, liver failure, and disseminated intravascular coagulation follow.