Primary peritonitis in children.

Abstract

Thirty-one children with primary peritonitis were studied. Most of them had been healthy prior to the onset of peritonitis and only one had nephrotic syndrome. There were 27 girls and four boys. The predominant organism in girls was pneumococcus, and in boys staphylococcus. The causative organisms, identified in 27 children, were all Gram positive. Most of the children were between four and 10 years of age. The onset of their illness was sudden with fever, vomiting and abdominal pain. Since in recent years, primary pneumococcal peritonitis has been the commonest type of peritonitis in young girls, our earlier policy of routine laparotomy for peritonitis was given up and in girls aged between four and ten, an attempt at initial pre-operative diagnosis was made by Gram's staining of peritoneal aspirate or vaginal swab. If Gram positive peritonitis was diagnosed, early cases were treated with antibiotics alone and late cases with antibiotics and minilaparotomy for drainage of pus. There was one death. Morbidity and mortality were higher when the period without treatment exceeded one week. The contribution of pre-operative diagnosis by Gram's staining to the provision of optimum treatment is emphasized.