Chronic Peritonitis

Overview

The peritoneum is a thin membrane that lines the inside of the abdomen and covers the organs within it. When this membrane becomes inflamed, the condition is called peritonitis. Most people are familiar with acute peritonitis, a sudden, severe emergency. Chronic peritonitis is different: it is a longer-lasting, often more gradual inflammation that develops over weeks to months.

Chronic peritonitis is usually a sign of an ongoing underlying problem rather than a disease in itself. Causes include slow-burning infections such as tuberculosis, complications of long-term peritoneal dialysis, and certain inflammatory conditions. Because the symptoms can be vague and develop slowly, the underlying cause sometimes takes time to identify, making careful evaluation important.

Symptoms

Symptoms tend to be persistent and build up gradually, rather than appearing suddenly.

• Ongoing or recurring abdominal pain or discomfort
• A swollen abdomen, sometimes from a buildup of fluid (ascites)
• Low-grade fevers or night sweats
• Loss of appetite and unintended weight loss
• Tiredness and a general feeling of being unwell
• Nausea or changes in bowel habits

In people on peritoneal dialysis, a cloudy dialysis fluid along with abdominal pain is an important warning sign. Sudden, severe worsening of pain with high fever should be treated as a possible emergency.

Causes

Chronic peritonitis reflects a persistent process irritating the peritoneum. Causes include:

• Tuberculosis: TB affecting the abdomen is a well-recognized cause of chronic peritoneal inflammation in many parts of the world.
• Peritoneal dialysis: Long-term dialysis through the abdomen can lead to repeated or persistent inflammation and infection.
• Other chronic infections: Certain fungal or unusual bacterial infections.
• Inflammatory conditions: Some autoimmune and inflammatory disorders can involve the peritoneum.
• Cancer: Tumors spreading to the peritoneum can cause chronic irritation, though this is a separate process.

Risk Factors

• Long-term peritoneal dialysis
• Exposure to or infection with tuberculosis
• A weakened immune system
• Certain chronic inflammatory or autoimmune diseases
• Previous abdominal infections or surgery

Diagnosis

Because chronic peritonitis has many possible causes, diagnosis focuses on finding the underlying reason:

• Examination and history: Including questions about dialysis, TB exposure, and other illnesses.
• Blood tests: To look for infection, inflammation, and clues to the cause.
• Imaging: CT or ultrasound to assess the peritoneum, fluid, and abdominal organs.
• Fluid analysis: Sampling abdominal fluid (or dialysis fluid) to test for infection, including TB, and other markers.
• Biopsy: Occasionally a tissue sample from the peritoneum is needed to confirm the cause.

Treatment

Treatment is directed at the underlying cause as well as at relieving symptoms.

• Treating infection: Tuberculous peritonitis is treated with a prolonged course of anti-TB medication; bacterial or fungal causes are treated with the appropriate antimicrobials.
• Managing dialysis-related peritonitis: Antibiotics, sometimes given into the abdominal cavity, and occasionally removal or replacement of the dialysis catheter.
• Treating inflammatory causes: Medicines to control the underlying autoimmune or inflammatory disease.
• Supportive care: Managing pain, nutrition, and fluid buildup.

Because some causes, such as TB, require long courses of treatment, follow-up is important to ensure the inflammation resolves.

Prevention

• Follow strict hygiene and technique with peritoneal dialysis to prevent infection
• Report cloudy dialysis fluid or abdominal pain promptly if you are on dialysis
• Seek evaluation and treatment for tuberculosis exposure or infection
• Manage chronic inflammatory conditions as advised
• Attend follow-up to confirm treatment is working

When to See a Doctor

See a doctor for persistent or recurring abdominal pain, a gradually swelling abdomen, ongoing low-grade fevers or night sweats, or unexplained weight loss. If you are on peritoneal dialysis, contact your team promptly for abdominal pain or cloudy dialysis fluid. Seek emergency care if abdominal pain becomes sudden and severe, with high fever, a rigid abdomen, or feeling very unwell, as this can indicate a more acute, dangerous problem.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Peritonitis.
2. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Peritoneal Dialysis.
3. Centers for Disease Control and Prevention (CDC). Tuberculosis (TB).
4. Mayo Clinic. Peritonitis - Symptoms and causes.