[Primary acute peritonitis in adults]

The authors report 12 cases of primary acute peritonitis-that were operated over a period of 10 years, representing 2.8% of the total number of acute cases of peritonitis, with the exclusion of cases of postoperative peritonitis. Since they are so rare it is understandable that primary acute peritonitis of the adult are less well known by the general practitioner in surgery. The particular background of these patients, frequently involving other forms of pathologic features, and the generally depressed immunological background explains the atypical clinical evolution, with attenuated local abdominal signs, a fact which retards the diagnosis, and hence the therapy. As a general rule adults come rather late in surgical departments, usually transferred from another department (diabetes, internal medicine, gynecology, communicable diseases, etc.). The surgeon also has difficulties in making a diagnosis. When the decision to operate has been taken--in most of the cases this happens at a late stage-peritonitis is usually is the purulent phase and careful drainage of the peritoneal cavity is necessary, associated to antibiotherapy that should be applied on the surgical table, and with massive doses. Preoperative etiological diagnosis is difficult. Direct bacterioscopy of the peritoneal exudate is decisive and it should be asked for by the surgeon even in the early stage of surgery. Exhaustive visceral surgical exploration, which should, in principle, eliminate secondary peritonitis is neither easy to perform, nor without risks in these patients, usually aged, obese, with multiple interventions in antecedents. Appendectomy, as a complementary gesture, is contraindicated. The prognosis in the adult, in contrast with that of children, is severe, with very high perioperative morbidity and mortality (above 50% in the authors' experience).