Presentation
Several days history of uncontrolled high-grade fever. Developed abdominal distension and signs of peritonitis.
Patient Data
Multiple loculated peritoneal collections with a thick enhancing wall, most of which show gas fluid levels, some of the collections are interconnecting. Largest loculated collection in the recto-uterine pouch measures 5 x 5 x 3.7 cm.
A small subcapsular hepatic collection is also noted.
Mild left-sided hydronephrosis probably due to compression of the upper ureter by one of the collections.
Case Discussion
The patient underwent laparoscopic surgery where extensive adhesions interfered with full evacuation; therefore converted to laparotomy. Multiple subcapsular hepatic abscesses were found. The bowel was inspected and there was no sign of perforation. Several drainage tubes were fixed for full drainage.
Peritonitis can be either primary or secondary:
- primary peritonitis is less common and usually seen in immune-compromised patients due to hematogenous disseminated bacterial infection
- secondary peritonitis is by far more common and usually due to direct involvement of the peritoneum by a visceral infection, bowel perforation, trauma or introduction of infection into a pre-existing sterile peritoneal fluid
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