M J Navia1, P L Caroli. 1. Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina. marcelojaviernavia@yahoo.com.ar
Abstract
INTRODUCTION: Primary peritonitis occurs rarely in childhood, affecting mainly children with nephrosis or liver disease and only rarely occurring in previously healthy children. The aim of this case report is to describe the clinical features and natural course of primary peritonitis in six previously healthy children and to review the literature on the topic. MATERIAL AND METHOD: The clinical features and course of primary peritonitis in six previously healthy children are described. The diagnosis was made at laparotomy, which showed no intraabdominal findings, such as intestinal perforation. RESULTS: Presentation was acute and all the patients presented within 24 h of onset of symptoms. The most common presenting features were fever (100 %) and abdominal pain (100 %). Leucocytosis (> 15,000/mm3) was observed in four patients (66 %). Microorganisms were isolated from peritoneal fluid in four patients (Escherichia coli in two, Streptococcus pneumoniae in one and Gram-negative bacteria in one). Recovery was rapid and no postoperative complications were observed. CONCLUSION: Primary peritonitis in patients without underlying causes is clinically indistinguishable from acute appendicitis and diagnosis is usually made at surgery. The hallmarks of therapy are antibiotics and prompt exploratory laparotomy with appendectomy and the prognosis is good.
INTRODUCTION:Primary peritonitis occurs rarely in childhood, affecting mainly children with nephrosis or liver disease and only rarely occurring in previously healthy children. The aim of this case report is to describe the clinical features and natural course of primary peritonitis in six previously healthy children and to review the literature on the topic. MATERIAL AND METHOD: The clinical features and course of primary peritonitis in six previously healthy children are described. The diagnosis was made at laparotomy, which showed no intraabdominal findings, such as intestinal perforation. RESULTS: Presentation was acute and all the patients presented within 24 h of onset of symptoms. The most common presenting features were fever (100 %) and abdominal pain (100 %). Leucocytosis (> 15,000/mm3) was observed in four patients (66 %). Microorganisms were isolated from peritoneal fluid in four patients (Escherichia coli in two, Streptococcus pneumoniae in one and Gram-negative bacteria in one). Recovery was rapid and no postoperative complications were observed. CONCLUSION:Primary peritonitis in patients without underlying causes is clinically indistinguishable from acute appendicitis and diagnosis is usually made at surgery. The hallmarks of therapy are antibiotics and prompt exploratory laparotomy with appendectomy and the prognosis is good.