• Bacterial peritonitis is usually Polymicrobial
  • The exception is primary peritonitis(spontaneous) – pure infection with pneumococcal (MC), Streptococcal or Haemophilus
  • E.coli is the most common organism found followed by streptococci and bacteroides
  • Primary bacterial peritonitis – Pneumococci
  • Secondary bacterial peritonitis – E.coli and Bacteroides
  • Most common bacteria causing abscess formation in peritonitis – Bacteroides fragilis 

Clinical features

  • Guarding and rigidity of abdomen
  • Rebound tenderness – Blumberg sign
  • Hippocratic facies 


  • Plain X ray erect (chest) – ground glass appearance and dilated gas-filled loops of bowel
  • Serum amylase is raised to more than 4 times normal in acute peritonitis

Exam Important

  • Moderately raised amylase levels are diagnostic of peritonitis.
  • A DPL with more than 500 leukocytes/mL is considered positive and suggests peritonitis.
  • The fluid in bacterial peritonitis generally demonstrates low pH and glucose as well as elevated protein and LDH levels. The drop in peritoneal fluid pH (and P02) is more pronounced in mixed infections and severe bacterial contamination, with increased numbers of anaerobic bacteria in these circumstances.
  • USG and CT scan are increasingly used to identify the cause of peritonitis (acute pancreatitis).
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