Peritonitis natural history

Peritonitis Main Page
Patient Information
Overview
Causes
Classification Spontaneous Bacterial Peritonitis Secondary Peritonitis
Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]

Overview

With treatment, patients usually do well. Without treatment, the outcome is usually poor. However, in some cases, patients do poorly even with prompt and appropriate treatment.

Natural History

If properly treated, typical cases of surgically correctable peritonitis (e.g. perforated peptic ulcer, appendicitis, and diverticulitis) have a mortality rate of about <10% in otherwise healthy patients, which rises to about 40% in the elderly, and/or in those with significant underlying illness, as well as in cases that present late (after 48h). If untreated, generalized peritonitis is almost always fatal.

Complications

• Sequestration of fluid and electrolytes, as revealed by decreased central venous pressure, may cause electrolyte disturbances, as well as significant hypovolaemia, possibly leading to shock and acute renal failure.
• A peritoneal abscess may form (e.g. above or below the liver, or in the lesser omentum).
• Sepsis may develop, so blood cultures should be obtained.

• The fluid may push on the diaphragm and cause breathing difficulties

Prognosis

SBP

• Peritonitis is a frequent cause of morbidity.The prognosis greatly depends on the degree of intra-abdominal contamination, the severity of underlying disease, the immune response of the host and associated organ dysfunction.Associated mortality rates vary from <1% to >60%. studies that reported spontaneous bacterial peritonitis (7062 patients), the median mortality was 43.7%: 31.5% at 1 month and 66.2% at 12 months.

Predictors for poor prognosis in SBP include:

• Older age
• Higher Child-Pugh scores
• Nosocomial origin
• Encephalopathy
• Elevated serum creatinine and bilirubin
• Ascites culture positivity
• Presence of bacteremia and
• Infections with resistant organisms.

Assessment of the severity of the peritonitis using MPI
Score	Mortality rate	Morbidity rate
<21	0%	13.33%
21-27	27.28%	65.71%
>27	100%	100%