Secondary peritonitis and intra-abdominal abscess
Intra-abdominal infection encompasses myriad pssibilities. The infection can be caused by virtually any pathogenic microorganism. Moreover, the infection can produce diverse manifestations, including visceral abscess, biliary tract involvement, localized or diffuse peritonitis, and intra-abdominal asbscess. The clinial presentation can range from subtle to immediately obvious. The patient's initial clinical state also varies considerably: Some patients may appear quite well, while others are catastrophically ill. In patients with few symptoms and subtle signs, intra-abdominal infection can escape detection for an extended period of time. It may also evade discovery in patients with primary extraperitoneal manifestations and those with unusual complaints. Even today, intra-abdominal infections are sometimes found only at exploratory laparotomy - and on occasion only at autopsy. Among the various types of intra-abdominal infections, secondary bacterial peritonitis (often accompanied by abscess formation) is a common clinical problem. By definition, such peritonitis is associated with a predisposing gastrointestinal lesion or event and should be differentiated from primary microbial peritonitis (an uncommon illness). The case to be described illustrates a number of aspects of secondary bacterial peritonitis: the possibility of an atypical history and atypical physical findings despite the presence of a typical predisposing disorder, the failure of a closed-space polymicrobial infection to respond to medical therapy alone, and the patient's response to surgical treatment.