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Spontaneous Peritonitis

Last updated Aug. 14, 2019

Approved by: Maulik P. Purohit MD, MPH

Spontaneous Peritonitis is an infection of the peritoneal (abdominal) cavity. It is usually the end-result of a severe kidney or liver disease.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Acute Generalized Peritonitis
  • Primary Bacterial Peritonitis
  • Spontaneous Bacterial Peritonitis (SBP)

What is Spontaneous Peritonitis? (Definition/Background Information)

  • Spontaneous Peritonitis is an infection of the peritoneal (abdominal) cavity. It is usually the end-result of a severe kidney or liver disease
  • The peritoneal cavity is a space between the parietal and visceral peritoneum, between the two membranes that separate the abdominal organs from the abdominal wall
  • Spontaneous Peritonitis is an acute bacterial infection most commonly caused by Escherichia coli and Klebsiella species. Hence, it is also known as Spontaneous Bacterial Peritonitis (SBP)
  • The condition may also be called ascitic fluid infection. Ascitic fluid (or ascites) is a fluid that abnormally accumulates in the peritoneal cavity, commonly in patients with end-stage liver damage
  • Common signs and symptoms of Spontaneous Peritonitis are abdominal pain and tenderness, fever, chills, nausea, vomiting, and altered mental status
  • Spontaneous Peritonitis is typically treated with intravenous antibiotics. However, the prognosis of the condition is not good. Even on intensive treatment, the death rate is between 10-30%

Who gets Spontaneous Peritonitis? (Age and Sex Distribution)

  • Spontaneous Peritonitis occurs both in adults and children. It is found commonly in individuals with liver cirrhosis
  • There is no gender predilection; both males and females are affected
  • The condition is observed worldwide; there is no racial or ethnic predilection

What are the Risk Factors for Spontaneous Peritonitis? (Predisposing Factors)

The risk factors associated with Spontaneous Peritonitis are primarily those that are associated with end-stage liver damage (or liver cirrhosis). These include:

  • Excess consumption of alcohol
  • Diseases, such as chronic viral hepatitis, that may lead to cirrhosis
  • Individuals with certain complex conditions such as heart failure and Budd-Chiari syndrome
  • Children affected by nephrosis, systemic lupus erythematosus, etc.
  • Patients undergoing dialysis procedure

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Spontaneous Peritonitis? (Etiology)

Spontaneous Peritonitis is a bacterial infection of the ascitic fluid that is present in the abdominal cavity. It may be caused by:

  • Accumulation of excess fluid in the peritoneal cavity (space between the membranes lining the abdomen and abdominal organs)
  • As an end result of severe kidney or liver disease
  • Commonly, bacteria such as Escherichia coli, Klebsiella pneumoniae, and Streptococcus pneumoniae may be responsible for the infection
  • Spontaneous Peritonitis may also occur after endoscopic treatment for esophageal or gastric conditions
  • The bacterial infection source may not be easily identifiable or apparent.

What are the Signs and Symptoms of Spontaneous Peritonitis?

The signs and symptoms exhibited by Spontaneous Peritonitis depend on the stage of the disease and usually include:

  • Fever and chills
  • Abdominal pain and bloating, abdominal tenderness
  • Low urine output
  • Diarrhea
  • Paralytic ileus: Disruption of the normal propulsive movement of the bowel
  • Hypotension
  • Hypothermia (low body temperature)
  • Altered mental status
  • Nausea and vomiting

How is Spontaneous Peritonitis Diagnosed?

The diagnosis of Spontaneous Peritonitis may include:

  • Complete evaluation of medical history along with a thorough physical exam
  • Blood culture
  • Peritoneal fluid analysis: A sample of the peritoneal fluid is sent to the laboratory and examined for the presence of white blood cells and bacteria responsible for the infection
  • Imaging tests such as CT or ultrasound scan of the abdomen

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Spontaneous Peritonitis?

Complications of Spontaneous Peritonitis may include:

Hepatic encephalopathy: Altered level of consciousness and coma, secondary to liver failure
Hepatorenal syndrome: A condition that is characterized by kidney failure, secondary to liver failure, without any intrinsic defect in the kidneys
Sepsis (blood poisoning): A condition in which there is whole body infection

How is Spontaneous Peritonitis Treated?

The treatment measures for Spontaneous Peritonitis may include:

  • The treatment shall be rendered in a hospital setting
  • Intravenous antibiotics are usually necessary and administered
  • Albumin combined with antibiotics help in reduction of renal impairment

The antibiotic medications used may include:

  • Beta lactams such as:
    • Ampicillin
    • Cefotaxime
    • Ceftriaxone
    • Ceftazidime
    • A combination of amoxicillin and clavulanic acid
  • Aminoglycosides such as:
    • Gentamicin
    • Tobramycin
  • Use of Cefotaxime has proved to be more effective

Administering antibiotics through veins (intravenously) may be for a prolonged duration (such as 10-14 days), as recommended by the healthcare provider.

How can Spontaneous Peritonitis be Prevented?

  • The risk for Spontaneous Peritonitis is assessed by the physician by performing tests and exams (including physical examination) on patients vulnerable to the condition
  • When undergoing certain surgical procedures, Spontaneous Peritonitis may be prevented through the suitable administration of antibiotics to individuals at risk for developing the same

What is the Prognosis of Spontaneous Peritonitis? (Outcomes/Resolutions)

  • The prognosis of Spontaneous Peritonitis is guarded despite treatment. The survival rate is 70-90% after appropriate and intensive treatment
  • The poor prognosis may be due to complications that develop, such as poor liver function, development of renal failure, hepatic encephalopathy, and  upper gastrointestinal bleeding

Additional and Relevant Useful Information for Spontaneous Peritonitis:

  • Peritoneal fluid is a pale yellow color fluid and consists of mainly cells, proteins, and other tissue factors. The peritoneal fluid analysis evaluates several characteristics of the peritoneal fluid

The following article link will help you understand peritoneal fluid analysis:

https://www.dovemed.com/common-procedures/procedures-laboratory/peritoneal-fluid-analysis/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 26, 2015
Last updated: Aug. 14, 2019