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Acute Peritonitis

purulent, peritoneum, inflammation, result, children and disease

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peritonitis may occur in childhood at any age. It may be pres ent in the fcetus, usually as a consequence of syphilis, and is then a frequent cause of miscarriage. It may arise in the- new-born infant as a result of pyamic infection, and is invariably fatal. It may occur at a later period of infancy or in childhood, either as a primary disease, or as a secondary mal ady complicating the course of some other illness. The infective form of peritonitis which occurs in the new-born baby, and is accompanied by jaun dice, is described elsewhere (see Jaundice). The present chapter deals only with the disease as it is seen in later infancy and childhood.

in the adult, inflammation of the peritoneum in children is often induced by traumatic causes. A blow or other injury to the abdo men will occasionally excite it, and it may arise as a consequence of punc ture of a hydatid cyst. The commonest of these causes is the extravasation of fluids from the bowel into the peritoneal cavity, owing to perforation of the intestine. In typhoid fever, and in ulceration of the vermiform appen dix or of the cmcum, this accident may happen, and a rapidly fatal issue to the illness usually follows. Dr. Robert Lee has referred to two cases in children, aged respectively eight and nine years, in whom perforation of the stomach induced the peritonitis. Sometimes a local inflammation of the peritoneum may become diffused, as when a typhlitis or perityphlifis, or an invaginated portion of the intestine sets up general peritoneal inflam mation. Mr. Curling has recorded the case of a little boy, aged two years, in whom the bruising of an midescended testicle produced this result. Again, inflammation may extend from the chest to the abdomen. I can now recall several cases in which a pleurisy has been followed by general inflammation'of the peritoneum. I have known this to happen in the first week of the illness, before the fluid had had time to become purulent ; but in most cases it occurs later, as a result of the passage of purulent infective matter from the pleural cavity along the lymphatics of the diaphragm to the peritoneum. In order that this extension should occur, there must, no

doubt, be present some special conditions conferring peculiar infective properties upon the purulent contents of the thorax. Dr. Burney Yeo has described the case of a schoolboy, between eleven and twelve years of age, who was attacked in the course of whooping-cough by pleuro-pneumonia of the left side of the chest. Nineteen days afterwards this was followed by general peritonitis, and the patient very rapidly succumbed. The same unfortunate accident happened to a little boy, eighteen months old, under my care in the East London Children's Hospital. The child had an attack of pleurisy. As the fluid did not become absorbed his chest was punctured and a quantity of purulent matter was evacuated. The operation had to be repeated several times, and at last, as the purulent fluid still continued to reaccumulate, a permanent opening was established in the chest-wall.

The boy seemed to be going on fairly well when extension of the inflam mation suddenly took place to the peritoneum and he soon died.

Peritonitis is sometimes a complication of the blood diseases. It is said occasionally to occur in scarlatina, and erysipelas may induce it. Abercrombie has referred to an epidemic of the latter distemper which occurred amongst the children in the Merchants' Hospital in Edinburgh in the year 1824. The disease was of a mild type, but two of the children rapidly died, and on examination pus was discovered in the abdominal cavity. Peritoneal inflammation is also common as a consequence of abdominal tuberculosis, but the subject of tubercular peritonitis will be considered separately.

Besides occurring as a result of the above causes, peritonitis may arise as a primary disease in a child in whom no deviation from health has been noticed. It is sometimes seen in school-children of either sex, and has been attributed by Gauderon to chilling of the surface after violent exercise, and by Legrand to lying prone upon the damp earth.

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