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Peritonitis - spontaneous

Spontaneous bacterial peritonitis (SBP)


Peritonitis is inflammation of the peritoneum. This is the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.



Spontaneous peritonitis is most often caused by infection in fluid that collects in the peritoneal cavity (ascites). The fluid buildup often occurs with advanced liver or kidney disease.

Risk factors for liver disease include:

  • Very heavy alcohol use
  • Chronic viral hepatitis (hepatitis B or hepatitis C)
  • Other diseases that lead to cirrhosis

Spontaneous peritonitis also occurs in people who are on peritoneal dialysis for kidney failure.

Peritonitis may be due to inflammation, infection, or injury of the intestines.




  • Abdominal pain and bloating
  • Abdominal tenderness
  • Fever
  • Low urine output

Other symptoms include:

  • Chills
  • Joint pain
  • Nausea and vomiting


Exams and Tests


Tests will be done to check for infection and other causes of abdominal pain:

  • Blood culture
  • White blood cell count in a sample of peritoneal fluid
  • Chemical examination of peritoneal fluid
  • Culture of peritoneal fluid
  • CT scan or ultrasound of the abdomen




Treatment depends on the cause of the peritonitis.

  • Surgery may be needed if peritonitis is caused by a foreign object, such as a catheter used in peritoneal dialysis.
  • Antibiotics may control infection in cases of spontaneous peritonitis with liver or kidney disease.
  • Intravenous therapy can treat dehydration.

You may need to stay in the hospital so health care providers can rule out conditions such as such as appendicitis and diverticulitis.


Outlook (Prognosis)


In most cases, the infection can be treated. However, kidney or liver disease may limit recovery.


Possible Complications


  • Hepatic encephalopathy
  • Hepatorenal syndrome
  • Sepsis


When to Contact a Medical Professional


Call your health care provider if you have symptoms of peritonitis. This can be a medical emergency situation.




Steps should be taken to prevent infection in people with peritoneal catheters.

Antibiotics may be used:

  • To prevent peritonitis from coming back in people with liver failure
  • To prevent peritonitis in people who have acute gastrointestinal bleeding due to other conditions




Garcia-Tiso G. Cirrhosis and its sequelae. In: Goldman L,Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 156.

Prather C. Inflammatory and anatomic diseases of the intestine, peritoneum, mesentery, and omentum. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 144.

Runyon BA. Ascites and spontaneous bacterialperitonitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Saunders Elsevier; 2010:chap 91.

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        Tests for Peritonitis - spontaneous


          Review Date: 8/11/2014

          Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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