PERITONITIS IN THE NEWBORN AND IN INFANTS Peritoneal inflammation may arise in foetal life, and lead to death of the foetus in utero or to malformations of the intestines and bile ducts (atresia). The cause may be syphilis, or not determinable.
In former years, peritoneal infection in the newborn, beginning in the umbilical wound, occurred epidemically in lying-in hospitals, together with puerperal fever; so that Bednar could assert that peri tonitis was more often encountered in the newborn than at any other period in the child's life. Of late, this form of peritonitis is seldom encountered: just as severe infections through the umbilicus have become rare.
Arteritis, gangrene of the umbilicus, and erysipelas are the most common causative factors.
Arteritis was the starting-point of acute general peritonitis in the only case I have observed in recent years. Suppuration had extended to the tunica vaginalis, and had led to abscess-formation (staphylococci) on the posterior surface of the testicle.
The diagnosis of peritonitis in infancy is often peculiarly difficult; many cases certainly are overlooked. Abdominal distention, with meteorism and colicky pains, is so much an every-clay occurrence in infants that one may easily fail to recognize those cases of peritonitis in which the amount of the inflammatory exudate is not large. There may be no vomiting, and little or no fever. The highest temperature recorded in the case of gonococcus peritonitis reported above was 37.8 C. (I00° F.). On careful examination, we shall usually recognize general peritonitis by the marked tension of the abdomen and the exquisite sensitiveness on pressure. The latter symptom may also be absent, as well as fever and vomiting.
The diagnosis is easier when the disease begins suddenly in fairly healthy children.
An infant four weeks old, whom I was treating for dyspepsia, suddenly began to suffer severe abdominal pain with abdominal dis tention and constipation. The child cried constantly; the abdomen was hard and tense, but there was no fever or vomiting. Death fol lowed on the third day. Postmortem showed a diffuse fibrinous and suppurative peritonitis, but no free exudate. The navel and the umbili cal vessels were perfectly normal; there was a mild grade of intestinal catarrh, but no ulceration. The appendix was normal. The bacterio
logical investigation showed only the bacterium eoli communis.
In infancy, the etiology of peritonitis is somewhat different from that in older children. Appendicitis, the most frequent cause in children over two years old, is rare in the first year of life; as is also encapsulated pneumococcus peritonitis, From a study of my autopsies, I should consider peritonitis in the first two years of life as a manifestation of that symptom-conlplex which Heubner has described in his text book as "multiple suppurative inflammation of the serous membrane." In accordance with Heublier's description, we find, associated with suppurative pericarditis and suppurative peritonitis, pleurisy with a thick, fibrinopttrulent, circumscribed exudate, without fluid pus, whence the infection seems to have spread. In one of my cases, meningitis was also present. Pneumococci and streptococci arc the exciting factors.
In the second class roust be considered those cases of peritonitis which originate in the intestines. It is a fact generally known that peritonitis is a quite unusual complication of the catarrhal diseases of infancy. I must, however, admit, after looking over iny post-mortem records, that I have seen peritonitis associated with every form of severe enteritis; and even with the milder catarrhal affections, as the fore going case of colon bacillus peritonitis shows. Baginsky had the same experience. Heubner emphasizes the occurrence of peritonitis in entero colitis. Most of the patients that I have seen were but a few weeks old.
I have seen perforation peritonitis in infants follow ulcerative processes, especially in the duodenum. In the third place, we must recollect that vulvovaginitis is by no means rare, even in the earliest Period of life. The above-mentioned ease of gonococcus peritonitis occurred in a child only a few weeks old.
Peritonitis as a symptom of general sepsis is by- no means so fre quently encountered in the newborn and the infant as earlier writers have reporteff; on the contrary, the peritoneum is usually intact, and one sees merely marked injection or small haunorrhages (Fischl).