Exploratory Laparotomy for Pneumococcal Peritonitis – A Case Report

This case report presents a 71-year-old patient, thin, without comorbidities, who underwent exploratory laparotomy due to acute abdominal pain with signs of peritonitis on physical examination, associated with leukocytosis and tomography with a small amount of free fluid in the cavity. During intraoperative the presence of pus was evident in the parietocolic drips and in the cul-de-sac, but without the presence of any injuries that would justify such a finding. The cavity was washed and the liquid collected for culture showed growth. of the bacterium Streptococcus pneumoniae, making the diagnosis pneumococcal peritonitis. The patient was treated with a regimen of ceftriaxone and metronidazole started empirically on admission and maintained after surgery, progressing satisfactorily and being discharged from hospital at the end of the seventh day of antibiotic therapy intravenous. Spontaneous bacterial peritonitis presents in patients with ascites secondary to liver disease or other causes such as neoplastic, renal or cardiac and its treatment is imminently clinical. The occurrence of peritonitis spontaneous bacterial infection in patients without ascites is uncommon and little described in the literature, with these cases being a great challenge in terms of diagnosis and management. Due to the clinical picture and laboratory tests, especially due to the finding of signs of peritonitis on physical examination, these patients are often subjected to exploratory laparotomy, showing a significant amount of intracavitary pus but without lesions that justify the cause. From the few reports available in the literature, a pattern of isolation of Streptococcus pneumoniae in the cultures of these cases, www.megajournalofcasereport.com Page 2 such as the patient described in this work. The pathophysiology is little understood and the clinical history does not have specific findings for the diagnosis. There is a pattern of greater occurrence of pneumococcal peritonitis in children and females, as well as some ...