Primary peritonitis in infancy and childhood.

Area of Science:

• Pediatric Surgery
• Infectious Diseases
• Gastroenterology

Background:

• Primary peritonitis is an infrequent cause of pediatric abdominal emergencies, representing 2.1% of cases.
• It frequently co-occurs with urinary or hepatic conditions, with urinary tract infections being the most common source of infection.
• Symptoms vary between infants and children, complicating preoperative diagnosis.

Purpose of the Study:

• To outline diagnostic criteria for primary peritonitis in children.
• To compare primary peritonitis with other causes of diffuse peritonitis.
• To analyze the shift in causative organisms and therapeutic approaches.

Main Methods:

• Retrospective analysis of pediatric patients diagnosed with primary peritonitis.
• Comparison of clinical presentation, diagnostic findings, and microbiological data.
• Review of treatment outcomes, including surgical versus non-surgical interventions.

Main Results:

• Key diagnostic indicators include a short symptom duration, concurrent urinary tract infection, and absence of free air on abdominal radiography.
• Gram-negative bacteria have become the predominant causative agents (69%), a shift from historical trends.
• Antibiotic therapy targeting gram-negative organisms and surgical intervention (exploratory laparotomy with appendectomy) are standard treatments.

Conclusions:

• Primary peritonitis requires a high index of suspicion, with specific clinical and radiological findings aiding diagnosis.
• The changing microbial landscape necessitates adjustments in antibiotic selection.
• Surgical intervention is generally indicated, but abdominal paracentesis may be considered in high-risk patients.