原發性腹膜炎的臨牀觀察

A Clinical Observation of Primary Peritonitis

陳逸光(Yi-Kuang Chen) ； 黃富源(Fu-Yuan Huang)

《Acta Paediatrica Sinica》 17卷1期 (1976/03) Pp. 37-39

摘要

在過去六年內，我們經驗了18個原發性腹膜炎的病例。以腹腔穿刺術得到診斷的有13例，這些病例都先以抗生素治療，於治療72小時後，其中11例症狀完全消失，因而沒有接受手術，另外2例因腹痛與發燒症狀無減輕，遂接受剖腹手術，症狀於手術後即消失。在其餘5例中，有2例因腹腔穿刺液塗片找不到細菌，另3例因無法與急性盲腸炎區分，所以接受剖腹術。肺炎球菌鏈球菌是引起原發性腹膜炎的主要細菌。但大腸桿菌與葡萄球菌亦偶有被發現。所有病例都完全康復，平均住院日數爲10天。腹腔穿刺術被認爲是診斷原發性腹膜炎最安全且最有價值的方法。原發性腹膜炎以抗生素治療72小時後，如症狀仍無改善，應即接受剖腹術。

並列摘要

During the past six years, eighteen children were diagnosed as having primary peritonitis at the Mackay Memorial Hospital. The age ranged from 4 to 12 years with an average of seven and a half years. Fifteen patients were female.
Abdominal pain, fever, irritability, vomiting, and tenderness, rigidity and distention of the abdomen were common symptoms and signs. Half of the patients had diarrhea. Bowel sounds were usually hypoactive, but were hyperactive initially in two cases.
The diagnosis of primary peritonitis was made by abdominal paracentesis of the aspicated fluid and positive culture in thirteen patients. Of which eleven were treated successfully with parenteral antibiotics alone. The clinical response in these cases was characterized by resolution of the symptoms and signs of peritonitis within seventy-two hours without surgery. Surgical exploration was performed in two patients because of persistence of fever and abdominal pain despite antibotics therapy for more than 72 hours. Other five patients received laparatomy shorthy after admission either because of failure to demonstrate bacteria on the smear of the aspirated fluid (2 cases), or the symptoms and signs mimicked that of acute appendicitis (3 cases). These 5 ptients responded to antibiotic therapy dramatically following the operation.
The commonest pathogenic organism responsible for the primary peritonitis in this series was pneumococcus. Streptococcus was less frequently found in two patients. E. coli was found in two, and staphylococcus in one patient respectively.
All of the 18 patients recovered completely, and the average duration of hospitalization was 10 days.