Secondary peritonitis differential diagnosis

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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]

Overview

Secondary peritonitis has to be differentiated from spontaneous bacterial peritonitis which is also seen in cirrhotics.

Differential Diagnosis

Differentiating secondary peritonitis from spontaneous bacterial peritonitis

Characteristic	Spontaneous bacterial peritonitis	Secondary peritonitis
Presentaion	Main manifestations of peritonitis are acute abdominal pain, tenderness, and guarding, which are exacerbated by moving the peritoneum, e.g. coughing, flexing the hips, or elicitingthe Blumberg sign (a.k.a. rebound tenderness)	Similar presentation but insidious onset unlike rapid onset in SBP
Microorganism	Monomicrobial involvement is common No identifiable source of intra-abdominal infection	Polymicrobial involvement is common Identifiable source of intra-abdominal infection, with or without perforation (surgically treatable source)
Diagnostic Criteria	SBP is diagnosed in the presence of: Ascitic fluid PMN count of  ≥250/mm3 No evident intra-abdominal source of infection Positive ascitic fluid bacterial culture	Diagnosed in the presence of Positive ascitic fluid bacterial culture Ascitic fluid PMN count of ≥250/mm3 Evidence of a source of infection (demonstrated at surgery or autopsy], either intra-abdominal or contiguous with the peritoneal cavity
Follow-up paracentesis	Ascitic fluid usually became sterile after one dose of antibiotic	Failure of the ascitic fluid to become culture-negative despite of initial antibiotic treatment, appears to be typical of secondary peritonitis due to continuous spillage of organisms into abdominal cavity which requires surgery.