3. Primary Peritonitis
3-9 years of age
Spreads from lower genitals
Commonly Pneumococci, E.Coli
Most common in malnourished
D.tapping
Laparotomy and peritoneal toileting
Broad spectrum Antibiotics
Peritoneal antibiotics
4. Secondary Peritonitis
Peritonitis due to underlying visceral
pathology
E.Coli 70%
Others Klebsiella, Streptococci,
staphylocooci.
Treatment of the underlying cause.
5. Tertiary Peritonitis
Occurs after any abdominal surgeries
Persistent or recurrent infection after
an adequate treatment for primary or
secondary peritonitis.
Occurs after 48 hours usually
Most common in immunocompromised.
Antibiotics, TPN, Laparotomy,
FFP/PRBC.
7. Spontaneous bacterial peritonitis
Peritonitis in the absence of any
visceral pathology.
A/w cirrhosis, nephrotic syndrome,
CHF.
MC E.Coli, Klebsiella
Never caused by Anearobic organism
Uncommon in malignant ascites
8. Causes:
1. Impaired GI motility
2.Decrease local and systemic
immunity
Clinical Features:
1. Sudden onset pain
2.Fever */vomiting
3.Tenderness
4.Guarding/rigidity
5.Tenderness on P/R
6.Distension with Silent Abdomen
21. CASE SCENARIO
• A 42 year-old male presented with c/o
worsening abdominal pain, nausea and
vomiting starting 3 days prior to
presentation.
• On admission, his history was remarkable
for four similar prior episodes over the
previous five years that lasted between 3
and 5 days.
• He denied any constipation, obstipation or
associated hematemesis, fevers, chills or
urinary symptoms.
22. He was evaluated at an outside health centre
and diagnosed with peptic ulcer disease and
was managed with omeprazole intermittently .
On examination he was afebrile, with a heart
rate of 120 beats/min, blood pressure
140/80mmHg and respiratory rate of 22/min.
Abdominal examination revealed mild
distension with generalized guarding and
marked rebound tenderness in the
epigastrium. .
There were no palpable masses and bowel
sounds were absent.
23. X-Ray Air under diaphragm
Abdominal ultrasonography revealed
free fluid throughout the abdomen and
pelvis.
24. An exploratory laparotomy with a
provisional diagnosis of a perforated
peptic ulcer and differential diagnosis of
ruptured appendicitis, midgut volvulus,
pancreatitis and typhoid perforation.
The peritoneum was accessed via a
vertical midline incision. Upon entering
the peritoneal cavity, approximately 2
litres of clear reddish brown fluid was
encountered and evacuated.
26. A perforation was noted in the third
part of duodenum which was closed by
Grahams live omental patch closure.
Patient general condition improved and
discharged.
