Peritonitis is significant swelling and infection of the tissues inside and surrounding the organs of the abdomen. It can be caused by conditions like a ruptured appendix, or perforated bowel. Other main causes include ascites, infection, tuberculosis or cancer. Treatments vary and depend upon the causes of peritonitis.
With almost all cases of peritonitis, pain is very severe. Few will not seek treatment, because the level of pain is incapacitating. Pain medication is a part of treatment of virtually all types of peritonitis.
Where the bowel has been perforated, peritonitis is an almost immediate result, because the bowel floods the abdominal cavity with bacteria. This is also true of a burst appendix. Both these forms are called secondary bacterial peritonitis. Treatment may include surgery to repair perforation of the bowel, or surgery to remove appendix tissues. Treatment always includes antibiotics, sometimes given initially at the hospital for several days through an intravenous (IV) line.
Those who have ascites, which are deposits of fluids in the abdominal cavity, are at risk for developing what is known as spontaneous bacterial peritonitis. In these cases, the excess fluids gathering in the abdominal space become infected. The severe pain felt by patients is an indicator of infection and irritation. Ascites tend to be treated with diuretics, which help reduce the fluid accumulation. As well, antibiotics are given for usually 14 days to rid the body of infection.
Ascites can also form because of cancer that has spread to the peritoneum, and in these cases, the areas of fluid accumulation do not respond to diuretics. Usually, the pain of this form of peritonitis also does not respond to antibiotics, since the cancer is causing the pain rather than infection. The goal of treating this cause of peritonitis is skillful pain management to help enhance the comfort of the patient. This may include draining the ascites, as well as giving pain medication to those affected.
Sometimes, the fluid of the peritoneum becomes infected without a known cause. Risk factors may include reduced liver function, but ascites is not present. This form of spontaneous bacterial peritonitis is as well treated with antibiotics. Antibiotics tend to improve the condition after one or two days.
Tubercular peritonitis is also treated with antibiotics, and is diagnosed by evaluating fluids taken from the abdomen. Those with tuberculosis usually must be isolated to prevent spread of the illness to others. Within a few weeks of treatment with antibiotics, however, they usually are able to resume regular activities.
In most cases, pain control and antibiotics are the main treatments. One rare form of peritonitis caused by a condition called Mediterranean fever, may also be treated with a medication called choline. Mediterranean fever may be caused by bites from dog ticks, or may be inherited. While the type caused by bites tends to respond to choline, inherited or familial Mediterranean fever is very difficult to treat, and peritonitis may recur.
