Peritonitis

Understanding Peritonitis: A Guide to Medical Standards and Malpractice

Peritonitis is a life-threatening medical emergency characterized by inflammation of the peritoneum—the thin, silk-like membrane that lines the inner abdominal wall and covers the organs within your abdomen. Because the peritoneum is responsible for protecting the abdominal cavity, any infection or irritation here can rapidly lead to sepsis, multi-organ failure, and death if not managed with extreme urgency. Consequently, peritonitis can be the basis for a medical malpractice claim.

In the legal and medical worlds, peritonitis is often the “smoking gun” of a surgical error or a diagnostic failure. When medical providers fail to identify the signs early or cause the condition through negligence, the results are almost always catastrophic.

What Causes Peritonitis?

Peritonitis is generally classified into two main categories: Primary and Secondary.

1. Primary Spontaneous Peritonitis (SBP)

This occurs when an infection develops within the peritoneal fluid without an obvious source of puncture or organ rupture. It is most common in patients with:

• Liver Cirrhosis: Fluid buildup (ascites) in the abdomen becomes a breeding ground for bacteria.
• Kidney Failure: Specifically patients undergoing peritoneal dialysis.

2. Secondary Peritonitis (The Most Common Form)

This is caused by the “leakage” of bacteria or foreign substances into the abdominal cavity from a hole (perforation) in the gastrointestinal tract. Peritonitis causes can involve medical malpractice and include:

• Ruptured Appendix: The most classic cause.
• Stomach Ulcers: A perforated ulcer allows stomach acid and bacteria to escape.
• Diverticulitis: Inflammation of small pouches in the colon that can tear.
• Pancreatitis: Inflammation of the pancreas can lead to infection of the surrounding area.
• Trauma: A knife or gunshot wound, or even a blunt force injury that ruptures an organ.

Risk Factors

While anyone can develop peritonitis, certain populations are at higher risk:

• Patients undergoing Peritoneal Dialysis: Contamination of the catheter or the surrounding site.
• Chronic Liver Disease: Conditions like Hepatitis or alcohol-related cirrhosis.
• History of Peritonitis: Previous episodes increase the likelihood of recurrence.
• Weakened Immune Systems: Patients with HIV/AIDS or those on chemotherapy.

Diagnosis: Providers, Tests, and Mechanisms

The diagnosis of peritonitis is a race against time. Delay in diagnosing peritonitis can be medical malpractice. The primary doctors involved in diagnosis are usually Emergency Medicine Physicians, Radiologists, and General Surgeons.

Diagnostic Tests and How They Work

• Physical Examination: Providers look for “rebound tenderness” (pain when pressure is released) and abdominal rigidity. A “board-like” abdomen is a classic sign of peritonitis.
• Blood Tests: Providers look for a high White Blood Cell (WBC) count. This indicates the body is aggressively fighting a massive infection. They may also run blood cultures to see if the infection has entered the bloodstream (sepsis).
• Imaging (CT Scan): The “Gold Standard.” A CT scan uses X-rays to create cross-sectional images. It can detect free air in the abdominal cavity (pneumoperitoneum), which proves an organ has perforated, or fluid collections (abscesses).
• Peritoneal Fluid Analysis (Paracentesis): A doctor uses a needle to withdraw a sample of fluid from the abdomen. If the lab finds a high white cell count or bacteria in this fluid, the diagnosis is confirmed.

Treatment: How Medical Teams Intervene

Once diagnosed, the patient is generally transferred to the care of General Surgeons, Infectious Disease Specialists, and Intensivists (ICU doctors).

The Treatment Protocol

1. Surgical Intervention (Source Control): In secondary peritonitis, surgery is mandatory. The surgeon must find the hole (in the appendix, colon, or stomach) and repair it. They also perform a “washout,” where the abdominal cavity is flushed with sterile saline to remove as much bacteria and debris as possible.
2. Intravenous (IV) Antibiotics: Patients are started on broad-spectrum antibiotics to kill the bacteria that have spread throughout the membrane.
3. Supportive Care: This includes IV fluids to prevent dehydration and vasopressors if the patient’s blood pressure drops due to septic shock.

Peritonitis Medical Malpractice: When Providers Fail

Peritonitis cases are frequent subjects of medical malpractice litigation because the “Standard of Care” for abdominal pain is very strict. Negligence typically falls into two categories: Causing the condition or Failing to treat it.

1. Medical Malpractice Claims for Causing Peritonitis (Surgical Errors)

These claims often arise after elective or routine surgeries (like a gallbladder removal or a hysterectomy).

• Bowel Perforation: During surgery, a doctor may accidentally nick or puncture the bowel. If this isn’t caught and repaired during the surgery, fecal matter leaks into the abdomen, causing peritonitis.
• Poor Sterile Technique: Failure to maintain a sterile field during surgery or dialysis catheter insertion can introduce the bacteria that trigger the infection.

2. Medical Malpractice Claims for Failure to Respond to Peritonitis (Diagnostic Errors)

This is perhaps the most common type of claim. It involves misdiagnosis, specifically a “failure to timely diagnose.”

• The “Dismissed” Patient: A patient goes to the ER with severe abdominal pain, but the doctor diagnoses them with “simple constipation” or “the flu” and sends them home without a CT scan. By the time the patient returns, the appendix has ruptured, and peritonitis has set in.
• Failure to Monitor Post-Op: If a patient shows signs of infection after surgery (fever, high heart rate, extreme pain) and the surgeon ignores these “red flags,” they may be liable for the delay in treating the resulting peritonitis.
• Radiological Errors: A radiologist may fail to see the “free air” or fluid on a CT scan that indicates a perforation.

The Impact of Peritonitis Medical Malpractice

Because peritonitis moves so quickly, a delay of even 12 to 24 hours can be the difference between a routine recovery and a month-long stay in the ICU, permanent colostomy bags, or death. In a legal sense, the plaintiff must prove that the provider’s deviation from the standard of care directly led to these increased “damages.”

If you have a potential peritonitis medical malpractice case, then visit our free consultation page or video. Then contact the Kopec Law Firm at 800-604-0704 to speak directly with Attorney Mark Kopec. He is a top-rated Baltimore medical malpractice lawyer. The Kopec Law Firm is in Baltimore and pursues cases throughout Maryland and Washington, D.C.