When should I consider referring a patient with peritonitis to secondary care for surgical intervention?

Consider referring a patient with peritonitis to secondary care for surgical intervention urgently if they present with signs of complicated intra-abdominal infection such as abdominal rigidity and guarding, which suggest bowel perforation and peritonitis. This is a surgical emergency requiring prompt specialist assessment and management to reduce morbidity and mortality.

In cases of suspected complicated acute diverticulitis with peritonitis, urgent hospital referral is indicated, especially if there is uncontrolled abdominal pain combined with signs such as abdominal rigidity, guarding, or systemic features of sepsis. Imaging (contrast CT) is typically performed in secondary care to confirm diagnosis and guide management, which may include laparoscopic lavage or resectional surgery depending on intraoperative findings.

For suspected appendicitis complicated by perforation and peritonitis, emergency hospital admission for specialist surgical assessment is recommended, particularly in high-risk groups such as pregnant women, elderly, and children. Delay in surgical intervention increases risk of morbidity and mortality.

In summary, any patient with clinical signs of peritonitis (rigidity, guarding, severe pain), systemic signs of sepsis, or suspected bowel perforation should be referred immediately to secondary care for surgical evaluation and intervention.

These recommendations are based on NICE and associated UK guidelines on diverticular disease, appendicitis, and acute abdominal emergencies.