Acute Peritonitis in Non-Perforated Pancreatitis

Pathophysiology and Clinical Presentation

The release of pancreatic enzymes and inflammatory mediators into the peritoneal cavity can cause peritonitis in non-perforated pancreatitis, as stated by the World Journal of Emergency Surgery and Gut 1, 2
The color of peritoneal fluid in acute pancreatitis, which ranges from clear to "prune juice," has prognostic significance, according to Gut 2
Patients with non-perforated pancreatitis may present with signs of peritonitis, including diffuse abdominal tenderness, as noted by Gut 2
In severe cases, body wall ecchymoses such as Cullen's sign or Grey-Turner's sign may be evident, as reported by Gut and Praxis Medical Insights 2, 3

Ultrasound examination can detect free peritoneal fluid in the abdomen, which may indicate peritonitis in the setting of pancreatitis, as stated by Gut and Praxis Medical Insights 2, 3
Contrast-enhanced CT (CE-CT) is the imaging modality of choice for diagnosis, staging, and detection of complications of acute pancreatitis, according to the World Journal of Emergency Surgery 4, 5
CT can help differentiate between pancreatitis with peritonitis and other causes of peritonitis, such as perforated viscus, as noted by the World Journal of Emergency Surgery 4, 5

The presence of peritonitis in non-perforated pancreatitis may indicate severe disease requiring intensive care management, as reported by the World Journal of Emergency Surgery 5
According to the determinant-based classification, non-perforated pancreatitis with peritonitis may be classified as moderate to severe depending on the presence of organ failure, as stated by the World Journal of Emergency Surgery 5
Peritoneal fluid sampling is not recommended as a routine procedure but may be useful in cases where the diagnosis is uncertain, as noted by Gut 2

Misdiagnosing peritonitis in non-perforated pancreatitis as perforated viscus can lead to unnecessary surgical intervention, as warned by Gut 2
Relying solely on clinical assessment for diagnosis is unreliable and may misclassify around 50% of patients, as reported by Gut 6
Performing early CT scan (within 72 hours of symptom onset) may not show necrotic/ischemic areas and may underestimate the severity of pancreatitis, as noted by the World Journal of Emergency Surgery and Praxis Medical Insights 3, 4