Secondary peritonitis pathophysiology

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

Pathophysiology

• Bacteria can reach the peritoneal cavity by a variety of pathologic processes:
  • Transmural inflammation with luminal obstruction,
  • Perforation of the GI tract, and
  • Intestinal ischemia.
• The initial inoculum of bacteria is determined by the normal flora in the involved portion of the GI tract.

Flora

Microbial cause of secondary peritonitis depends on the site of the gut perforation.

• Small bowel perforation: Consist mainly of enterococci and Escherichia coli
• Distal small bowel lumen perforation: Mostly Enterobacteriaceae and anaerobic organisms, including the Bacteroides sps.
• Colon: Mostly anaerobes (e.g. Peptostreptococcus, Clostridium, and most commonly Bacteroides sps)