Primary peritonitis in infancy and childhood.

Primary peritonitis, rarely diagnosed preoperatively, is an uncommon disease accounting for 2.1% 
of all pediatric abdominal emergencies. It is often associated with urinary 
or hepatic pathology, the former the source of the infecting organism 
in the majority of cases, and presents with characteristic symptoms depending 
upon whether it occurs in infancy or childhood. The symptoms and 
signs which allow for a positive prospective diagnosis are illustrated by 
comparing this disease to those entities with which it is most 
often confused, e.g. diffuse peritonitis of other etiologies, and include a 
short duration of symptoms, associated urinary tract infection and an absence 
of free air on abdominal roentgenograms. In the past, gram positive 
organisms were the most common infecting agent; however, in this series 
gram negative bacteria accounted for 69% or the organisms. Antibiotics with 
a gram negative spectrum and exploratory laparotomy with appendectomy are the 
hallmarks of therapy, the latter replaced by abdominal tap only in 
the patient who satisfies the criteria for primary peritonitis and in 
whom an associated disease makes the risk of surgery prohibitive. 