Peritonitis: Causes

Pathogenesis (development of disease)

Primary peritonitis (1% of peritonitis) occurs without identifiable infection. It usually develops from ascites. The exact cause is still unclear, but hematogenous pathogen seeding (streptococci, pneumococci) is thought to be involved. In this case, ascites represents an ideal culture medium. In secondary peritonitis, bacterial seeding (usually by bacteria from the intestine) into the abdomen (abdominal cavity) occurs through a portal of entry from a hollow organ. Furthermore, bacteria can migrate through the intestinal wall, due to inflammatory and/or malignant (malignant) changes of the abdominal organs, even without perforation (peritonitis). As part of the inflammation, there is a systemic inflammatory reaction with edema formation and thus threatening fluid loss. Further consequences are local abscesses and adhesions with the omentum majus (“large mesh”).

Etiology (causes)

Disease-related causes.

Diseases that can lead to primary peritonitis:

Respiratory system (J00-J99)

  • Angina tonsillaris – inflammation of the lymphatic pharyngeal ring.
  • Pneumonia (inflammation of the lungs)

Cardiovascular system (I00-I99)

  • Heart failure (cardiac insufficiency)
  • Lymphedema

Infectious and parasitic diseases (A00-B99).

Liver, gallbladder and bile ducts – pancreas (pancreas) (K70-K77; K80-K87).

  • Chronic hepatitis (inflammation of the liver).
  • Liver cirrhosis (connective tissue remodeling of the liver leading to functional impairment) → portal hypertension (portal hypertension; portal hypertension; permanent increase in pressure in the portal vein > 10 mmHg); 15% of these patients develop spontaneous bacterial peritonitis (SBP)

Musculoskeletal system and connective tissue (M00-M99).

Neoplasms – tumor diseases (C00-D48).

  • (Metastatic) neoplasms, unspecified.

Note: Primary peritonitis can also occur in otherwise healthy individuals. Conditions that may lead to secondary peritonitis:

Cardiovascular (I00-I99).

Infectious and parasitic diseases (A00-B99).

Liver, gallbladder, and bile ducts-pancreas (pancreas) (K70-K77; K80-K87).

  • Cholecystitis (gallbladder inflammation).
  • Pancreatitis (inflammation of the pancreas)

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Acute mesenteric ischemia (AMI; intestinal infarction, mesenteric artery occlusion, mesenteric infarction, mesenteric occlusive disease, angina abdominalis).
  • Appendicitis (appendicitis).
  • Diverticulitis – disease of the colon in which inflammation is formed in protrusions of the mucosa (diverticula)) with perforation.
  • Incarcerated inguinal hernia – incarcerated inguinal hernia.
  • Gastric/intestinal perforation (intestinal perforation) – intestinal perforation can occur due to:
    • Inflammation
    • Ulceration (ulceration)
    • Chronic inflammatory bowel disease
    • Iatrogenic (due to medical interventions) e.g. endoscopic examinations/surgeries.
    • Vascular (vascular) as in ischemia (reduced blood flow), embolism (occlusion of a blood vessel).
    • Obstruction / ileus (intestinal obstruction).
    • Neoplasms
    • Foreign body
  • Anastomotic insufficiency after gastrointestinal tract surgery.

Neoplasms – tumor diseases (C00-D48)

  • (Metastatic) neoplasms, unspecified.

Pregnancy, childbirth, and puerperium (O00-O99).

  • Extrauterine pregnancy – pregnancy outside the uterus; extrauterine pregnancy is present in approximately 1% to 2% of all pregnancies: Tubargravidity (tubal pregnancy), ovariangravidity (pregnancy in the ovary), peritonealgravidity or abdominalgravidity (abdominal pregnancy), cervicalgravidity (pregnancy in the cervix).

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

Causes (external) of morbidity and mortality (V01-Y84).

  • Incidents of surgical procedures/medical treatment.

Injuries, poisonings, and other consequences of external causes (S00-T98)

  • Hemorrhage into the abdominal cavity
  • Bile leakage after liver puncture (liver biopsy; tissue removal from the liver).
  • Gastric/intestinal perforation due to foreign body
  • Injuries to the abdominal cavity and/or internal organs, blunt or penetrating

Other causes

  • Continuous ambulatory peritoneal dialysis (CAPD).
  • Cerebrospinal fluid drainage – drainage of cerebrospinal fluid into the abdomen; performed for hydrocephalus (hydrocephalus).
  • Condition after radiotherapy (radiotherapy) of the abdominal organs / peritoneum.

Medication

  • Intraperitoneal chemotherapy – chemotherapeutic agents delivered directly into the abdominal cavity.
  • Immunosuppressants