Primary peritonitis in previously healthy children--clinical and bacteriological features

A prospective study of cases of primary peritonitis in children at the Korle-Bu Teaching Hospital, Accra, was undertaken to find diagnostic clinical and aetiological features of the disease. Seventeen children, 15 females and two males, diagnosed as primary peritonitis underwent laparotomy with peritoneal toiletting. Peritoneal exudate and high vaginal swabs (HVS) were taken under anaesthesia for bacteriological analysis. Patients were followed up for one month. Thirteen patients (70%) were aged between 6 to 10 years. Presentation was early (65% presented in less than 48hrs of onset of symptoms). The commonest presenting feature were fever (100%) and abdominal pain (100%) in the absence of headache (100%). All had classical signs of diffuse peritonitis. There was leucocytosis in 15 cases (88%). No bacterial growth was obtained in 50% of cases cultured. Pneumococcus was the commonest organism isolated (33.3%). Of the 7HVS taken, 4 did not yield any bacterial growth and 2 grew escherichia coli but no pneumococcus. There was no correlation between the bacteriological findings of the peritoneal exudate and the HVS. Post-operative complications were few, insignificant and there was no mortality recorded. Sixty five percent (11/17) of cases could be predicted from the clinical symptoms and signs. The results of this study do not support any aetiological theory of causation.