Peritonitis refers to any form inflammation of the peritoneum.
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Pathology
Peritonitis can be be localized or generalized, and may be infective or non-infective in etiology:
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primary: from diffuse bacterial infection of the peritoneal cavity occurring without loss of integrity of the digestive tract.
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secondary
acute infection of the peritoneal cavity, usually resulting from perforation or anastomotic disruption of the digestive tract (e.g. fecal peritonitis)
sometimes arise from acute abdominal inflammatory conditions, peritoneal dialysis, and systemic infections
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may result from sterile involvement of the peritoneum such as in eosinophilic peritonitis or encapsulating peritoneal sclerosis
may also be due to chemical peritoneal irritation (e.g. barium peritonitis) of with situations such as biliary or vernix caseosa peritonitis
Specific types
Radiographic features
CT
CT features can vary dependent if whether it is acute or chronic. Key features are peritoneal thickening, peritoneal enhancement +/- fluid. Three different patterns have been described:
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smooth uniform pattern
peritoneal thickening is regular and of uniform thickness
shows a smooth interface with the omental fat
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irregular pattern
peritoneal thickening shows a nonuniform thickness with focal segments being thicker than others; the interface between the thickened peritoneum
omental fat appears rough and irregular
focal thicker segments show an obtuse angle with the peritoneum
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nodular pattern
peritoneal thickening is absent or minimal
well-defined variably sized nodules of soft tissue attenuation (individually seen along the peritoneum) and outlined by the adjacent omental fat
Differential diagnosis
In appropriate clinical scenarios consider:
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