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[Primary acute peritonitis in adults].

D Rădulescu, E Păcescu

    Revista De Chirurgie, Oncologie, Radiologie, O.R.L., Oftalmologie, Stomatologie. Chirurgie
    |March 1, 1989
    PubMed
    Summary

    Primary acute peritonitis is rare in adults, often presenting with subtle symptoms and delayed diagnosis. This condition carries a high risk of complications and mortality, necessitating prompt surgical intervention and aggressive antibiotic therapy.

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    Area of Science:

    • General Surgery
    • Infectious Diseases
    • Abdominal Surgery

    Context:

    • Primary acute peritonitis is a rare surgical emergency, accounting for 2.8% of acute peritonitis cases excluding postoperative origins.
    • Adult patients often have comorbidities and compromised immunity, leading to atypical presentations and delayed diagnosis.
    • Referrals from other departments (e.g., diabetes, internal medicine) are common, complicating initial surgical assessment.

    Purpose:

    • To highlight the diagnostic and therapeutic challenges of primary acute peritonitis in adults.
    • To emphasize the importance of early surgical intervention and appropriate management strategies.
    • To underscore the poor prognosis associated with this condition in the adult population.

    Summary:

    • A 10-year study of 12 adult cases revealed primary acute peritonitis presents atypically with subdued abdominal signs, delaying diagnosis and treatment.
    • Surgical management involves prompt drainage and massive antibiotic doses, with preoperative etiological diagnosis being difficult.
    • Direct bacterioscopy of peritoneal exudate is crucial; exhaustive exploration is risky in elderly, obese patients with prior surgeries. Appendectomy is contraindicated.

    Impact:

    • The study underscores the severe prognosis in adults, with perioperative morbidity and mortality exceeding 50%.
    • Highlights the need for increased awareness among general practitioners and surgeons regarding this rare condition.
    • Emphasizes the critical role of early diagnosis, aggressive treatment, and appropriate surgical techniques for improving outcomes.

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