A new etiology of acute abdominal emergencies in cirrhotic patient: secondary pneumococcal peritonitis with jejunitis.
We report the first case of secondary pneumococcal peritonitis associated with acute jejunitis in a 52-year-old homeless Child-Pugh C cirrhotic man without ascitis. The patient was admitted with clinical signs of peritonitis, and jaundice. Morphologic examination was unremarkable. A laparotomy revealed a diffuse peritonitis, and an acute jejunitis with prenecrotic lesion. The lesion was located within the first centimeters of the jejunum, immediately after the duodeno-jejunal angle, extented on 15 cm. A resection of the first 15 cm of the jejunum was performed with duodeno-jejunal side-to-side manual anastomosis. Gram-stain and cultures of blood, peritoneal pus, and jejunal mucosa revealed a penicillin-sensitive Streptococcus pneumoniae. Appropriate parenteral antibiotic treatment was initiated (aminopenicillin). The postoperative course was marked by a transient hepatic failure associated with an ascitis controlled by diuretics. The patient was discharged on the 26th day after surgery. This case reports a new etiology of acute abdominal emergencies in cirrhotic patients.
Regimbeau
J M
JM
Service de Chirurgie Générale et Digestive Hôpital Lariboisière, 2, rue Ambroise Pare, 75475 Paris, France.
Mognol
P
P
Panis
Y
Y
Pocard
M
M
Laisne
M J
MJ
Riche
F
F
Nemeth
J
J
Valleur
P
P
D000006:Abdomen, Acute / Q000209:etiology*; D000714:Anastomosis, Surgical; D004386:Duodenum / Q000601:surgery; D004630:Emergencies; D004751:Enteritis; D006801:Humans; D007579:Jejunal Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D007583:Jejunum / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000175:diagnosis*; D011008:Pneumococcal Infections / Q000150:complications / Q000175:diagnosis*