ACUTE PERITONITIS

THE PERITONEUM
ACUTE PERITONITIS
Most cases of peritonitis are caused by an invasion of the peritoneal cavity by bacteria. Bacterial peritonitis is usually polymicrobial , both aerobic and anaerobic organisms.
Bacteriology :enumerated in box 58.3
Diseases (e.g. obstruction ,achlorhydria, diverticula) may increase proximal colonization of gastrointest tract. The biliary and pancreatic tracts are normally
free from bacteria, although they may be infected in disease, e.g. gallstones. Peritoneal infection is usually caused by two or more bacterial strains. Bacteroides are commonly found in peritonitis. These organisms are sensitive to metronidazole, clindamycin, lincomycin and cephalosporin compounds.
Non-gastrointestinal causes of peritonitis
Pelvic infection via the fallopian tubes is responsible for a high proportion of ‘non-gastrointestinal’ infections. Immunodeficient patients, for example those with human immunodeficiency virus (HIV) infection or those on immunosuppressive treatment, may present with opportunistic peritoneal infection, e.g. Mycobacterium avium-intracellulare (MAI)