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Clinical features of generalised peritonitis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The clinical features of generalised peritonitis include:

  • patient is systemically very ill - fever, tachycardia, prostration
  • postural hypotension - there may be a massive exudation of inflammatory fluid into the peritoneal cavity causing hypovolaemia
  • severity of symptoms depends on cause of the peritonitis:
    • if there is infection, i.e. faeces, pus, infected bile, then the initial presentation may not be severe initially; eventually, with spread the peritonitis becomes very severe
    • with chemical peritonitis, e.g. perforated peptic ulcer, then the initial presentation may be very severe but becomes less so with inflammatory dilution

  • on examination:
    • rigidity of the abdominal wall
    • diffuse abdominal tenderness
    • bowel sounds may be absent because of peristaltic paralysis
    • if there is severe peritonitis, e.g. faecal, there may be signs of gram-negative bacteraemic shock, i.e. hypotensive, cold patient
    • rectal tenderness
  • radiographically:
    • may be air under the diaphragm if perforated viscus
    • the majority of patients will show signs of intestinal ileus

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