[A report of generalized secondary peritonitis]

Acute peritonitis not treated within the first 24-48 hours leads to complications that have to be solved by the surgeon. These complications represent MOF and the prognosis of the case is reserved. Our case has the following features: young female of 29 years of age admitted into the hospital in the gynaecologic department as she was in pain in the hypogastric area with suspicion of diagnosis by bilateral metroanexite. She had her coil devise removed three weeks before. After wards she followed the prescribed treatment with powerful antibiotics. After six days of medical treatment, she suffers of abdominal meteorisma and vomits, she laks fever and has leucocytes 6200/mmc. The surgeon performs the physical examination and confirms the diagnosis of occlusion; X-ray show high hydroaeric level. The patient is operated after a short preparation. We found inside the abdomen a gangrenous appendix, a lot of pus in Douglas space and right tubar salpinx very inflamed. We performed the apendicectomy, the right salpingectomy and lavage and multiple drains. The patient left the surgical department two weeks after and in good shape. Our conclusion is that the case had a wrong diagnosis, it was misdiagnosed as the patient had dynamic occlusion. The clinical/physical examination was the decisive factor in taking the decision to operate.