Peritonitis - secondary

Alternative names
Secondary peritonitis

Secondary peritonitis is an inflammation (irritation) of the peritoneum (the membrane lining the abdominal cavity) caused by another condition, most commonly the spread of an infection from the digestive organs or bowels.

Causes, incidence, and risk factors

Secondary peritonitis has several major causes. Bacteria may enter the peritoneum via a hole (perforation) in the gastrointestinal tract, which can be caused by a ruptured appendix, stomach ulcer or perforated colon. The condition can also occur when pancreatic enzymes leak into the peritoneum during pancreatitis or when bile leaks from the biliary tract due to injury, because these chemicals can irritate the peritoneum.

Foreign contaminants can also cause secondary peritonitis if they get into the peritoneal cavity. This can occur during use of Peritoneal dialysis catheters.

Inflammation of the peritoneal cavity caused by bacteria can result in infection of the bloodstream (Sepsis) and severe illness.

Secondary peritonitis can also affect premature babies who have necrotizing enterocolitis.


  • Abdominal pain  
  • Abdominal distention  
  • Fever  
  • Thirst  
  • Low urine output

Note: There may be signs of shock.

Signs and tests
Vital signs (temperature, pulse, rate of breathing, blood pressure) may show fever, rapid heart rate and breathing, and Low Blood pressure.

Tests your doctor may order:

  • Blood tests for white cell count (a marker of infection)  
  • X-rays or CAT scan  
  • Blood culture  
  • Peritoneal fluid culture

Surgical treatment is usually necessary to remove sources of infection such as infected bowel, inflamed appendix, or an abscess. General treatment includes intravenous fluids, antibiotics, and use of medications to treat pain.

Expectations (prognosis)
The outcome depends on the underlying cause, the duration of symptoms before treatment, and the general health of the patient. Outcomes can range from complete recovery to overwhelming infection and death, depending on these factors.


  • Septic shock  
  • Abscess  
  • Intraperitoneal adhesions

Calling your health care provider
Call your health care provider if you develop symptoms of peritonitis. This is a serious condition that typically requires emergency medical treatment.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.