Primary peritonitis in an adolescent boy

Area of Science:

• Pediatric Surgery
• Infectious Diseases
• Gastroenterology

Background:

• Primary peritonitis is uncommon in healthy children, often presenting with nonspecific symptoms mimicking secondary peritonitis.
• Diagnosis is frequently delayed, typically confirmed intraoperatively due to the absence of unique clinical indicators.

Observation:

• A previously healthy 15-year-old boy presented with acute enteritis, rapidly progressing to acute abdomen and septic shock.
• Abdominal CT revealed intra-abdominal air, leading to an emergency laparotomy for suspected perforation.
• The surgery found purulent peritonitis but no identifiable perforation, indicating primary peritonitis.

Findings:

• Empirical broad-spectrum antimicrobial therapy was initiated and adjusted, successfully treating septic shock and complications.
• The source of the primary peritonitis remained unidentified.
• The patient recovered fully and remained asymptomatic post-discharge.

Implications:

• Primary peritonitis in children necessitates emergency surgery due to nonspecific, rapidly evolving symptoms.
• Prompt diagnosis, appropriate antibiotics, and supportive care lead to favorable prognoses.
• This case highlights the importance of considering primary peritonitis in pediatric acute abdomen, even without predisposing factors.