Primary peritonitis: an enigmatic case and literature exploration-diagnostic challenges and therapeutic approaches...

Primary peritonitis, also known as spontaneous peritonitis, is rare and has no obvious intra-abdominal origin. Antibiotic therapy is usually sufficient. However, surgery is sometimes necessary when the primary character of the peritonitis is uncertain. We report herein the case of a 24-year-old patient, with no particular medical history and who presented to the emergency department for diffuse abdominal pain with fever. Abdominal examination found diffuse abdominal tenderness with hyperleukocytosis. A computed tomography scan showed generalized intraperitoneal effusion with no obvious abdominal infectious hotbed, nor pneumoperitoneum. However, it showed lateral basal pneumonia. Laparoscopic exploration confirmed the diagnosis of peritonitis but didn´t find any obvious cause. She had a peritoneal cleansing with an appendectomy of principle. Then she was put on probabilistic broad-spectrum parenteral antibiotic therapy. However bacteriological examination of the peritoneal fluid and blood cultures were negative. The surgical postoperative course was uneventful and she was discharged at post-operative day 5.