Signs and symptoms of peritonitis include:

• Abdominal pain or tenderness
• Bloating or a feeling of fullness (distention) in your abdomen
• Fever
• Nausea and vomiting
• Loss of appetite
• Diarrhea
• Low urine output
• Thirst
• Inability to pass stool or gas
• Fatigue

If you're receiving peritoneal dialysis, peritonitis symptoms also include:

• Cloudy dialysis fluid
• White flecks, strands or clumps (fibrin) in the dialysis fluid

When to see a doctor
Peritonitis can be life-threatening if it's not treated promptly. Contact your doctor immediately if you have severe pain or tenderness of your abdomen, abdominal bloating, or a feeling of fullness associated with:

• Fever
• Nausea and vomiting
• Low urine output
• Thirst
• Inability to pass stool or gas

If you're receiving peritoneal dialysis, contact your health care provider immediately if your dialysis fluid is cloudy, if it contains white flecks, strands or clumps (fibrin), or if it has an unusual odor, especially if the area around your catheter is red or painful. These may be signs of peritonitis.

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Infection of the peritoneum can happen for a variety of reasons. Here are the most common causes of peritonitis:

• Peritoneal dialysis. Dialysis removes waste products and extra fluid from your blood when your kidneys can no longer adequately do so. With peritoneal dialysis, the network of tiny blood vessels in your abdomen (peritoneal cavity) is used to filter your blood. Peritonitis is the most common complication associated with peritoneal dialysis. An infection may occur during peritoneal dialysis due to unclean surroundings, poor hygiene or contaminated equipment.
• Fluid buildup. Diseases that cause liver damage, such as cirrhosis, can result in a large amount of fluid buildup in your abdominal cavity (ascites). That fluid buildup is susceptible to bacterial infection. This type of peritonitis is called spontaneous peritonitis.

Secondary peritonitis
When other medical conditions result in an infection that causes peritonitis, it's referred to as secondary peritonitis. These causes include:

• A ruptured appendix, stomach ulcer or perforated colon. Any of these conditions can allow bacteria to get into the peritoneum through a hole in your gastrointestinal tract.
• Pancreatitis. Inflammation of your pancreas (pancreatitis) complicated by infection may lead to peritonitis if the bacteria spread outside the pancreas.
• Diverticulitis. Infection of small, bulging pouches in your digestive tract (diverticulitis) may cause peritonitis if one of the pouches ruptures, spilling intestinal waste into your abdomen.
• Trauma. Injury or trauma may cause peritonitis by allowing bacteria or chemicals from other parts of your body to enter the peritoneum.

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Factors that increase your risk of peritonitis include:

• Peritoneal dialysis. Peritonitis is common among people undergoing peritoneal dialysis.
• Other medical conditions. The following medical conditions increase your risk of developing peritonitis: cirrhosis, appendicitis, Crohn's disease, stomach ulcers, diverticulitis and pancreatitis.
• History of peritonitis. Once you've had peritonitis, your risk of developing it again is higher than it is for someone who has never had peritonitis.

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Left untreated, peritonitis can extend beyond your peritoneum, where it may cause:

• A bloodstream infection (bacteremia).
• An infection throughout your body (sepsis). Sepsis is a rapidly progressing, life-threatening condition that can cause shock and organ failure.

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To diagnose peritonitis, your doctor will talk with you about your medical history and perform a physical exam. When peritonitis is associated with peritoneal dialysis, your signs and symptoms, particularly cloudy dialysis fluid, may be enough for your doctor to diagnose the condition.

In cases of peritonitis in which the infection may be a result of other medical conditions (secondary peritonitis) or in which the infection arises from fluid buildup in your abdominal cavity (spontaneous peritonitis), your doctor may recommend the following tests to confirm a diagnosis:

• Peritoneal fluid analysis. Using a thin needle, your doctor may take a sample of the fluid in your peritoneum (paracentesis). If you have peritonitis, examination of this fluid may show an increased white blood cell count, which typically indicates an infection or inflammation. A culture of the fluid may also reveal the presence of bacteria.
• Blood tests. A sample of your blood may be drawn and sent to a lab to check for a high white blood cell count. A blood culture also may be performed to determine if there are bacteria in your blood.
• Imaging tests. Your doctor may want to use an X-ray to check for holes or other perforations in your gastrointestinal tract. Ultrasound may also be used. In some cases, your doctor may use a computerized tomography (CT) scan instead of an X-ray.

The above tests may also be necessary if you're receiving peritoneal dialysis and a diagnosis of peritonitis is uncertain after a physical exam and examination of the dialysis fluid.

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To treat peritonitis, your doctor will likely prescribe an antibiotic medication to fight the infection and prevent it from spreading. The type and duration of your antibiotic therapy depend on the severity of your condition and the kind of peritonitis you have.

You may need to be hospitalized for peritonitis that's caused by infection from other medical conditions (secondary peritonitis). Surgery is often necessary to remove infected tissue, treat the underlying cause of the infection and prevent the infection from spreading.

If you're undergoing peritoneal dialysis and you have peritonitis, your doctor may recommend that you receive dialysis in another way for several days while your body heals from the infection. If peritonitis persists or recurs, you may need to stop having peritoneal dialysis entirely and switch to a different form of dialysis.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

If you're receiving peritoneal dialysis, your doctor may give you instructions about peritonitis self-care and provide you with antibiotics and other supplies for treatment of peritonitis at home. Always keep a supply of these items at home. If you suspect you may have peritonitis, contact your doctor right away.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Often, peritonitis associated with peritoneal dialysis is caused by germs around the catheter. If you're receiving peritoneal dialysis, take the following steps to prevent peritonitis:

• Wash your hands, including underneath your fingernails and between your fingers, before touching the catheter
• Clean the skin around the catheter with antiseptic every day
• Store your supplies in a sanitary area

If you've had spontaneous peritonitis before, or if you have peritoneal fluid buildup due to a medical condition such as cirrhosis, your doctor may prescribe antibiotics to prevent peritonitis.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.