Peritonitis and Abdominal Sepsis Differential Diagnoses

Updated: Jul 23, 2019
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Praveen K Roy, MD, MSc  more...
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Diagnostic Considerations

Thoracic processes with diaphragmatic irritation (eg, empyema), extraperitoneal processes (eg, pyelonephritis, cystitis, acute urinary retention), and abdominal wall processes (eg, infection, rectus hematoma) may mimic certain signs and symptoms of peritonitis. Always examine the patient for the presence of external hernias to rule out intestinal incarceration.

According to Adler and Gasbarra, the following should be considered in the differential diagnosis [10] :

  • Chemical irritants (eg, bile, blood, gastric juice, barium, enema or douche contents)

  • Chronic peritoneal dialysis

  • Chylous peritonitis

  • Eosinophilic peritonitis

  • Familial Mediterranean fever

  • Fungal infections (eg, histoplasmosis, cryptococcosis, coccidioidomycosis)

  • Granulomatous peritonitis (eg, parasitic infestations, sarcoidosis, tumors, Crohn disease, starch granules)

  • Gynecologic disorders (Chlamydia peritonitis, salpingitis, endometriosis, teratoma, leiomyomatosis, dermoid cyst)

  • Human immunodeficiency virus (HIV)-associated peritonitis (from opportunistic organisms)

  • Mesothelial hyperplasia and metaplasia

  • Neoplasms (eg, primary mesothelioma, secondary carcinomatosis, Pseudomyxoma peritonei)

  • Parasitic infections (eg, schistosomiasis, ascariasis, enterobiasis, amebiasis, strongyloidiasis)

  • Perforated viscus

  • Peritoneal encapsulation

  • Peritoneal loose bodies and peritoneal cysts

  • Peritoneal lymphangiectasis

  • Pyelonephritis

  • Sclerosing peritonitis

  • Splenosis

  • Vascular conditions (eg, mesenteric embolus, mesenteric nonocclusive ischemia, ischemic colitis, portal vein thrombosis, mesenteric vein thrombosis)

  • Vasculitis (eg, systemic lupus erythematosus, allergic vasculitis [Henoch-Schönlein purpura], Kohlmeier-Degos disease, polyarteritis nodosa)

Differential Diagnoses