Peritonitis

Question 1

What is peritonitis?

Answer 1

Inflammation of the peritoneum, usually due to bacterial infection.

• Primary (spontaneous bacterial peritonitis, rare)
• OR Secondary (MC due to perforated viscus, appendicitis, trauma, bowel obstruction)

Question 2

Aetiology

Answer 2

1. Perforated appendix (MC in children)
2. Bowel perforation (necrotising enterocolitis, trauma, obstruction)
3. Post-surgical infection
4. Spontaneous bacterial peritonitis (immunocompromised children)

Question 3

Main RF

Answer 3

1. Young age - neonates and infants
2. Abdominal trauma
3. Underlying bowel disease (e.g., Hirschsprung’s, IBD)
4. Immunocompromised or malnutrition
5. Previous abdominal surgery

Question 4

Sx

Answer 4

1. Severe abdominal pain (often diffuse)
2. Vomiting
3. Fever
4. Lethargy + irritability in young children
5. Abdominal distension

Question 5

3 signs suggestive of peritonitis

Answer 5

1. Rigid, tender abdomen
2. Guarding and rebound tenderness
3. Reduced bowel sounds

Signs of shock (tachycardia, hypotension) if severe!

Question 6

IX

Answer 6

1. FBC + CRP + blood cultures
2. Abdominal XR - free air if perforated
3. US - detects abscess/fluid collection

If dx unclear → consider paracentesis (rare)

Question 7

Mx of peritonitis

Answer 7

1. Stabilisation - IV fluids, correct electrolytes + oxygen
2. IV broad abx covering gram-negative and anaerobes
3. Surgery to repair perforation or remove the source/drainage (if needed)

Supportive care: monitor for sepsis, organ dysfunction

Question 8

4 complications

Answer 8

1. Sepsis / septic shock
2. Abscess formation
3. Bowel obstruction (adhesions)
4. Multi-organ dysfunction if delayed treatment

Question 9

For spontaneous bacterial peritonitis (SBP) in children, the main organisms are typically gut-derived bacteria:

Answer 9

1. Gram-negative enteric bacteria: E. coli, Klebsiella species
2. Gram-positive cocci: S. pneumoniae, Enterococcus species
3. Occasionally anaerobes

It’s usually monomicrobial and occurs in children with ascites or immunocompromised children