Chronic Peritonitis

What chronic peritonitis is

The peritoneum produces a small amount of fluid that lets the bowel glide smoothly. When it is chronically inflamed, it thickens, produces excess fluid (ascites) and can form adhesions or a fibrous shell that binds the bowel loops together.

Causes

Tuberculous peritonitis

Tuberculosis can spread to the peritoneum from the lungs, gut or lymph nodes. It is the most common cause of chronic peritonitis worldwide. Risk factors include HIV, cirrhosis, diabetes, peritoneal dialysis, and living in or coming from countries with high TB rates. Features include ascites, fever, night sweats, weight loss and belly pain developing over weeks to months. Some people have a "doughy" abdomen from thickened peritoneum.

Peritoneal dialysis-related peritonitis

People on peritoneal dialysis are at risk of repeated infections of the peritoneum. Recurrent or relapsing episodes can cause long-term inflammation and damage the membrane's ability to filter.

Sclerosing peritonitis (encapsulating peritoneal sclerosis)

Sclerosing peritonitis is a rare, serious condition in which the peritoneum thickens and wraps the small bowel in a fibrous cocoon. It is most linked to many years of peritoneal dialysis, especially after stopping, and can also follow certain medicines (such as practolol in the past), abdominal surgery, infection or occur without a known cause. It leads to repeated bowel obstruction, weight loss and malnutrition.

Familial Mediterranean fever and inflammatory conditions

Familial Mediterranean fever causes recurrent attacks of fever and peritonitis-like belly pain lasting 1 to 3 days. Repeated attacks can cause adhesions. Lupus and other autoimmune diseases can also inflame the peritoneum (serositis).

Foreign-body and chemical peritonitis

Talc, starch from surgical gloves, gallstones spilled during surgery, barium or a ruptured dermoid cyst can cause a chronic granulomatous inflammatory reaction.

Conditions that can mimic chronic peritonitis

• Peritoneal carcinomatosis: cancer spread to the peritoneum, from ovarian, stomach, bowel or pancreatic cancer
• Peritoneal mesothelioma
• Ascites from cirrhosis or heart failure

Symptoms

• dull, persistent or recurring abdominal pain
• swelling of the belly from fluid
• low-grade fever and night sweats
• poor appetite, nausea and weight loss
• changes in bowel habit
• episodes of vomiting and colicky pain from partial bowel obstruction
• cloudy dialysis fluid in people on peritoneal dialysis

Diagnosis

• Paracentesis: a needle sample of the abdominal fluid. Tests include cell count, protein, culture, cytology for cancer cells, and adenosine deaminase (ADA), which is high in tuberculous peritonitis.
• Blood tests: inflammation markers, blood count, kidney and liver function, and TB tests (interferon-gamma release assay).
• CT scan: shows thickened peritoneum, ascites, enlarged lymph nodes, calcification or a bowel cocoon.
• Laparoscopy with biopsy: the most reliable way to confirm tuberculosis or cancer.
• Genetic testing for familial Mediterranean fever.

Treatment

• Tuberculous peritonitis: a standard multi-drug TB regimen for at least 6 months.
• Dialysis-related peritonitis: antibiotics into the dialysis fluid; repeated infections may require catheter removal and a switch to hemodialysis.
• Sclerosing peritonitis: stopping peritoneal dialysis, nutritional support (sometimes IV nutrition), steroids or tamoxifen in some cases, and specialist surgery to free the bowel (enterolysis).
• Familial Mediterranean fever: daily colchicine prevents attacks and long-term complications.
• Foreign-body peritonitis: sometimes steroids or surgery.
• Supportive care: pain control, draining ascites when needed, and nutrition.

Outlook

Tuberculous peritonitis usually responds well to treatment if diagnosed promptly, although adhesions can cause later bowel problems. Sclerosing peritonitis carries significant risk, but outcomes have improved with specialist surgery and nutritional care. Familial Mediterranean fever is well controlled with colchicine.

Frequently asked questions

What is chronic peritonitis?

Chronic peritonitis is long-lasting or recurrent inflammation of the peritoneum, the membrane lining the abdomen. It develops over weeks to months and causes vague belly pain, swelling, fever and weight loss. Common causes include tuberculosis, peritoneal dialysis and sclerosing peritonitis.

What is the difference between acute and chronic peritonitis?

Acute peritonitis comes on suddenly, often from a burst appendix or perforated bowel, with severe pain and a rigid belly, and needs emergency surgery. Chronic peritonitis develops slowly with milder symptoms and is usually treated by addressing its specific cause.

Can tuberculosis cause peritonitis?

Yes. Tuberculous peritonitis is the most common cause of chronic peritonitis worldwide. It causes fluid in the belly, fever, night sweats and weight loss. Diagnosis often needs fluid testing and a biopsy, and it is treated with at least 6 months of TB medicines.

What is sclerosing peritonitis?

Sclerosing peritonitis, or encapsulating peritoneal sclerosis, is a rare condition in which the peritoneum thickens and encases the bowel in a fibrous layer. It is linked mainly to long-term peritoneal dialysis and causes bowel obstruction and malnutrition. Specialist surgery can help.

Is chronic peritonitis curable?

Many causes can be cured or controlled, including tuberculous peritonitis and dialysis-related infections. Familial Mediterranean fever is controlled with colchicine. Sclerosing peritonitis is harder to treat but can improve with nutritional support and surgery.