Nonoperative antiinfective treatment of intraabdominal infections

Streptococcus pneumoniae primary peritonitis mimicking acute appendicitis in an immunocompetent patient: a case report and review of the literature

Introduction

Primary peritonitis without an identifiable intra-abdominal source is extremely rare in healthy individuals; it is commonly seen in cases of nephrotic syndrome, cirrhosis and end-stage liver disease, ascites, immunosuppression, and inflamed peritoneum due to pre-existing autoimmune and oncological conditions.

Case presentation

We present the case of a 68-year-old Caucasian woman operated on due to acute abdomen with a provisional diagnosis of acute appendicitis. During the operation a small amount of free intra-abdominal fluid was found. Her uterus, ovaries, and fallopian tubes were macroscopically normal. Therefore, with the suspicion of appendicitis, appendectomy was performed. Her blood cultures were negative while peritoneal fluid was positive for capsulated form of Streptococcus pneumoniae. A 30-day follow-up was performed and she was asymptomatic without any sign of infection.

Discussion

Streptococcus pneumoniae commonly causes upper respiratory tract infection and cutaneous infections. It very rarely causes gastrointestinal infection and it is very rarely responsible for primary peritonitis and septic shock syndrome.

Conclusion

Pneumococcal peritonitis has a rare occurrence and represents a clinical challenge because of its subtle and non-specific clinical findings. The interest in our case lays in the relatively rare diagnosis of primary peritonitis mimicking acute appendicitis.

[Relaparotomy in secondary peritonitis Planned relaparotomy or relaparotomy on demand?]

Secondary peritonitis is associated with serious morbidity and a persistent high mortality in recent decades, this despite improvement in antibiotic, intensive care and surgical treatment. The available literature regarding the surgical treatment of secondary peritonitis was searched through Pubmed (1966- January 2005) as well as a hand search of references of retrieved articles. Definitions, pathophysiology and classification of secondary peritonitis are discussed, as well as the scientific rationale for the surgical treatment in secondary peritonitis. The historical development and the scientific foundation of present-day relaparotomy strategies in secondary peritonitis are evaluated, with an emphasis on two frequently applied surgical treatment strategies: planned relaparotomy and relaparotomy on demand. Criteria for relaparotomy after the initial laparotomy and potential areas for further research to reduce both morbidity and mortality are discussed. Furthermore, the care of patients with secondary peritonitis is evolving from a surgical entity to a more multidisciplinary challenge uniting surgeons, intensivists, radiologists and microbiologists. Research needs to be expanded into novel fields to further decrease morbidity and mortality.

PERITONITE FECAL EM RATOS: EFICÁCIA DA LAVAGEM DA CAVIDADE PERITONEAL COM SOLUÇÃO DE CLORETO DE SÓDIO A 0,9%

O presente estudo tem por objetivo analisar a influência da irrigação da cavidade peritoneal com solução de cloreto de sódio 0,9 % em ratos com peritonite fecal. Foram utilizados 36 ratos da linhagem Wistar, adultos ,machos ,pesando entre 160 e 210g. Estes animais foram alocados em três grupos iguais e submetidos a peritonite com homogeneizado de fezes humanas. No grupo I , o procedimento foi realizado para verificar a eficácia da peritonite fecal e todos os animais morreram após 24 horas da injeção intraperitoneal. Após 6 horas de evolução da peritonite, os ratos do grupo II foram submetidos a laparotomia e irrigação cavidade abdominal com solução de cloreto de sódio a 0,9 %. Neste grupo todos os animais permaneceram vivos após 48 horas da laparotomia. No grupo III, os ratos foram submetidos a laparotomia e limpeza da cavidade peritoneal com gaze estéril. Foi verificado que somente 6 ratos permaneceram vivos após 48 horas da laparotomia. O presente estudo demonstrou que a irrigação da cavidade peritoneal com solução de cloreto de sódio a 0,9 % foi capaz de reduzir os índices de mortalidade em ratos com peritonite fecal.