Peritonitis - Symptoms and causes (2023)



Peritonitis is a serious condition that starts in the abdomen. That's the area of the body between the chest and the pelvis. Peritonitis happens when the thin layer of tissue inside the abdomen becomes inflamed. The tissue layer is called the peritoneum. Peritonitis usually happens due to an infection from bacteria or fungi.

There are two types of peritonitis:

  • Spontaneous bacterial peritonitis. This infection is caused by bacteria. It can happen when someone has liver disease, such as cirrhosis, or kidney disease.
  • Secondary peritonitis. Peritonitis can happen due to a hole, also called a rupture, inside an organ in the abdomen. Or it can be caused by other health conditions.

It's important to get treatment fast for peritonitis. Health care providers have ways to clear out the infection. They also can treat any medical problem that might be causing it. Peritonitis treatment usually involves medicines that are used for infections caused by bacteria, called antibiotics. Some people with peritonitis need surgery. If you don't get treatment, peritonitis can lead to a serious infection that spreads through the body. It can be deadly.

A common cause of peritonitis is a treatment for kidney failure called peritoneal dialysis. This treatment helps get rid of waste products from the blood when the kidneys struggle to do that job themselves. If you get peritoneal dialysis, you can help prevent peritonitis with good hygiene before, during and after dialysis. For example, it's important to wash your hands and clean the skin around your catheter.


Symptoms of peritonitis include:

  • Belly pain or tenderness.
  • Bloating or a feeling of fullness in the abdomen.
  • Fever.
  • Upset stomach and vomiting.
  • Loss of appetite.
  • Diarrhea.
  • Reduced urine.
  • Thirst.
  • Not able to pass stool or gas.
  • Feeling tired.
  • Confusion.

If you get peritoneal dialysis, peritonitis symptoms also may include:

  • Cloudy dialysis fluid.
  • White flecks, strands or clumps — which are called fibrin — in the dialysis fluid.

When to see a doctor

Peritonitis can be life-threatening if you don't get treatment quickly. Call your health care provider right away if you have severe pain or tenderness of your abdomen, bloating or a feeling of fullness along with:

  • Fever.
  • Upset stomach and vomiting.
  • Reduced urine.
  • Thirst.
  • Not able to pass stool or gas.

If you get peritoneal dialysis, call your health care provider right away if your dialysis fluid:

  • Is cloudy or has an unusual color.
  • Has white flecks in it.
  • Has strands or clumps in it.
  • Smells unusual, especially if the area around your catheter is changes color or is painful.

Peritonitis also might happen after a burst appendix or a serious injury to your abdomen

  • Get medical help right away if you have severe belly pain. It may feel so bad that you can't sit still or find a comfortable position.
  • Call 911 or get emergency medical care if you have severe belly pain after an accident or injury.

Request an appointment

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.


Peritoneum infection is usually caused by a hole in an organ in the abdomen, such as the stomach and colon. The hole is also called a rupture. It's rare for peritonitis to happen for other causes.

Common causes of a hole that leads to peritonitis include:

  • Medical procedures
    • Peritoneal dialysis uses tubes, also called catheters, to remove waste products from the blood. An infection may happen during peritoneal dialysis due to an unclean treatment room, poor hygiene or tainted equipment.
    • Peritonitis also may happen after digestive surgery.
    • Use of feeding tubes can lead to peritonitis.
    • Peritonitis can happen after a procedure to take out fluid from your abdomen, such as for the condition ascites in liver disease.
    • In rare cases, it can be a complication of an exam to check inside the rectum and colon called colonoscopy.
    • Peritonitis can happen after a procedure to check the digestive tract called endoscopy. This is also rare.
  • A ruptured appendix, stomach ulcer or hole in the colon. Any of these conditions can allow bacteria to get into the peritoneum through a hole in your digestive tract.
  • Pancreatitis. This is inflammation of a gland in the abdomen called the pancreas. If you have pancreatitis and you get an infection, bacteria could spread outside the pancreas. That may lead to peritonitis.
  • Diverticulitis. Infection of small, bulging pouches in the digestive tract may cause peritonitis. This could happen if one of the pouches breaks open. The burst pouch could spill waste from the intestine into the abdomen.
  • Trauma. Injury may cause peritonitis. This could allow bacteria or chemicals from other parts of the body to get into your peritoneum.

Peritonitis that happens without a hole or tear is called spontaneous bacterial peritonitis. It's usually a complication of liver disease, such as cirrhosis. Advanced cirrhosis causes a lot of fluid buildup in your abdomen. That fluid buildup could lead to a bacterial infection.

Risk factors

Some things that raise the risk of peritonitis are:

  • Peritoneal dialysis. Peritonitis can happen in people who get this treatment.
  • Other medical conditions. Certain conditions raise your risk of getting peritonitis, such as:
    • Liver cirrhosis.
    • Appendicitis.
    • Stomach ulcers.
    • Diverticulitis.
    • Crohn's disease.
    • Pancreatitis.
  • History of peritonitis. Once you've had peritonitis, your risk of getting it again may be higher than that of someone who's never had it.


Without treatment, peritonitis may cause a whole-body infection called sepsis. Sepsis is very dangerous. It can cause shock, organ failure and death.


Peritonitis that's linked with peritoneal dialysis is often caused by germs around the catheter. If you use peritoneal dialysis, take these steps to prevent peritonitis:

  • Wash your hands before you touch the catheter. Scrub under your fingernails and between your fingers.
  • Clean the skin around the catheter with an antiseptic every day.
  • Store your supplies in a clean place.
  • Wear a surgical mask during your dialysis fluid exchanges.
  • Talk with your dialysis care team about the correct care for your peritoneal dialysis catheter.

Your health care provider may prescribe antibiotics to prevent peritonitis, especially if you've had peritonitis before. Antibiotics also might be prescribed if you have a buildup of peritoneal fluid due to a medical condition such as liver cirrhosis. If you take medicine called a proton pump inhibitor, you may be asked to stop taking it.

By Mayo Clinic Staff

Request an appointment

April 06, 2023


  1. Yu ASL, et al., eds. Peritoneal dialysis. In: Brenner & Rector's The Kidney. 11th ed. Elsevier; 2020. Accessed Oct. 14, 2022.
  2. Ferri FF. Peritonitis, secondary. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. Accessed Oct. 14, 2022.
  3. Treatment methods for kidney failure: Peritoneal dialysis. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Accessed Oct. 14, 2022.
  4. Runyon BA. Spontaneous bacterial peritonitis in adults: Treatment and prophylaxis. Accessed March 13, 2020.
  5. Acute abdominal pain. Merck Manual Professional Edition. Accessed March 13, 2020.
  6. Picco MF (expert opinion). Mayo Clinic. March 24, 2015.
  7. Doherty GM, ed. Peritoneal cavity. In: Current Diagnosis & Treatment: Surgery. 15th ed. McGraw Hill; 2020. Accessed Oct. 14, 2022.
  8. AskMayoExpert. Spontaneous bacterial peritonitis (adult). Mayo Clinic; 2019.
  9. Runyon BA. Spontaneous bacterial peritonitis in adults: Diagnosis. Accessed March 13, 2020.
  10. Feehally J, et al., eds. Complications of peritoneal dialysis. In: Comprehensive Clinical Nephrology. 6th ed. Elsevier; 2019. Accessed March 20, 2020.
  11. Salzer WL. Peritoneal dialysis-related peritonitis: Challenges and solutions. International Journal of Nephrology and Renovascular Disease. 2018; doi:10.2147/IJNRD.S123618.
  12. Spontaneous bacterial peritonitis (SBP). Merck Manual Professional Edition. Accessed Oct. 14, 2022.
  13. Friedman S, et al., eds. Complications of cirrhosis: Ascites & hepatic Encephalopathy. In: Greenberger's Current Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy. 4th ed. McGraw Hill; 2022. Accessed Oct. 17, 2022.
  14. Burkart JM. Clinical manifestations and diagnosis of peritonitis in peritoneal dialysis. Accessed Oct. 17, 2022.
  15. Burkart JM. Risk factors and prevention of peritonitis in peritoneal dialysis. Accessed Oct. 17, 2022.
  16. Li PK, et al. ISPD peritonitis recommendations: 2022 update on prevention and treatment. Peritoneal Dialysis International. 2022; doi:10.1177/08968608221080586.
  17. Bennett JE, et al. Peritonitis and Intraperitoneal Abscesses. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020. Accessed Oct. 18, 2022.


Associated Procedures

  • Blood transfusion
  • CT scan
  • Ultrasound
  • X-ray



Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

Advertising & Sponsorship


  • Peritonitis


What is peritonitis and what are 3 possible causes? ›

Peritonitis is a redness and swelling (inflammation) of the lining of your belly or abdomen. This lining is called the peritoneum. It is often caused by an infection from a hole in the bowel or a burst appendix. You must seek medical care right away.

What is the main symptom of peritonitis? ›

Peritonitis can be life-threatening if you don't get treatment quickly. Call your health care provider right away if you have severe pain or tenderness of your abdomen, bloating or a feeling of fullness along with: Fever. Upset stomach and vomiting.

What is the most common cause of peritonitis? ›

Secondary infection is the most common cause of peritonitis. It can be caused by: A burst appendix (appendicitis).

What is the most common type of peritonitis seen in patients? ›

The most common type of peritonitis is secondary peritonitis, usually caused by leakage or perforation of an abdominal organ, like the appendix. However, another common type of peritonitis is spontaneous bacterial peritonitis (SBP) which is most often associated with individuals that have abdominal ascites fluid.

What are the 3 stage of peritonitis? ›

Stages of peritonitis

1) reactive (first 24 hours); 2) toxic (24-72 hours); 3) terminal (over 72 hours) with bacterial-septic shock and without it.

What bacteria causes peritonitis? ›

Escherichia coli, streptococci (mostly pneumococci), and Klebsiella cause most episodes of spontaneous bacterial peritonitis in patients who are not receiving selective intestinal decontamination (Garcia-Tsao 1992).

What are the red flags of peritonitis? ›

Peritonitis – acute pain with signs of shock, rebound tenderness and a rigid abdomen. Ruptured AAA – pain radiating to the back or groin, patient may be in shock, pulsatile mass present.

Can constipation cause peritonitis? ›

Constipation in peritoneal dialysis (PD) is an infrequent but potentially serious condition affecting the mechanical properties of dialysis techniques and predisposing to bacterial intestinal translocation and eventual enteric peritonitis.

What part of the body is affected by peritonitis? ›

Peritonitis is inflammation of the membranes of the abdominal wall and organs. Peritonitis is a life-threatening emergency that needs prompt medical treatment. The abdominal organs, such as the stomach and liver, are wrapped in a thin, tough membrane called the visceral peritoneum.

What parasite causes peritonitis? ›

Among helminth infections, ascariasis is frequently responsible for intestinal obstacles than taeniasis, for the reason that ascariasis can lead to the intestinal obstruction, appendicitis, pancreatitis, biliary lesions, and peritonitis in children [2].

What is the most common cause of secondary peritonitis? ›

Notably, whereas appendicitis is the most common source of secondary peritonitis, it typically occurs in younger patients with fewer comorbidities and is associated with lower morbidity and mortality.

How rare is peritonitis? ›

Primary peritonitis in the absence of risk factors is uncommon. Only 50 such cases in otherwise healthy adults have been reported. The major infecting organisms in these cases were mostly group A Streptococcus and Streptococcus pneumoniae (Table 1).

What is the first line of peritonitis? ›

Piperacillin/tazobactam is the preferred first-line treatment, with a low percentage of drug-resistant bacteria.

How quickly does peritonitis develop? ›

How fast does peritonitis develop? Peritonitis is a medical emergency that requires prompt medical attention, as it develops very rapidly. Upon rupture of the abdominal wall or abdominal organs, the peritoneum can become infected within 24 to 48 hours.

How does a patient with peritonitis present? ›

Patients with severe peritonitis often avoid all motion and keep their hips flexed to relieve the abdominal wall tension. The abdomen is often distended, with hypoactive-to-absent bowel sounds. This finding reflects a generalized ileus and may not be present if the infection is well localized.

What is the peritonitis? ›

Peritonitis is inflammation of the membranes of the abdominal wall and organs. Peritonitis is a life-threatening emergency that needs prompt medical treatment. The abdominal organs, such as the stomach and liver, are wrapped in a thin, tough membrane called the visceral peritoneum.

What is peritonitis and how is it treated? ›

Spontaneous bacterial peritonitis can be life-threatening. You'll need to stay in the hospital. Treatment includes antibiotics. It also includes supportive care to ease your symptoms.

What are the two types of peritonitis and what are they? ›

The two main types of peritonitis are primary spontaneous peritonitis, an infection that develops in the peritoneum; and secondary peritonitis, which usually develops when an injury or infection in the abdominal cavity allows infectious organisms into the peritoneum. Both types of peritonitis are life-threatening.

What is a perforative peritonitis? ›

Perforative peritonitis is the most common surgical emergency in general surgical practice. Gastrointestinal perforation is the etiology in the vast majority of the patients. However, occasionally, other rare causes may be encountered. One such cause of peritonitis is spontaneous perforation of non-gravid uterus.

Top Articles
Latest Posts
Article information

Author: Golda Nolan II

Last Updated: 24/09/2023

Views: 6098

Rating: 4.8 / 5 (58 voted)

Reviews: 89% of readers found this page helpful

Author information

Name: Golda Nolan II

Birthday: 1998-05-14

Address: Suite 369 9754 Roberts Pines, West Benitaburgh, NM 69180-7958

Phone: +522993866487

Job: Sales Executive

Hobby: Worldbuilding, Shopping, Quilting, Cooking, Homebrewing, Leather crafting, Pet

Introduction: My name is Golda Nolan II, I am a thoughtful, clever, cute, jolly, brave, powerful, splendid person who loves writing and wants to share my knowledge and understanding with you.