Last revised by Henry Knipe on 28 Nov 2023

Peritonitis refers to any form inflammation of the peritoneum.

Peritonitis can be be localized or generalized, and may be infective or non-infective in etiology:

  • infective peritonitis

    • bacterial peritonitis

      • primary: from diffuse bacterial infection of the peritoneal cavity occurring without loss of integrity of the digestive tract.

      • 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

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:

  • smooth uniform pattern

    • peritoneal thickening is regular and of uniform thickness

    • shows a smooth interface with the omental fat

  • 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

  • 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

In appropriate clinical scenarios consider:

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