Primary peritonitis with pneumococcus is associated with -

• Primary pneumococcal peritonitis may complicate nephrotic syndrome or cirrhosis in children. • Otherwise healthy children, particularly girls between 3–9 years of age, may also be affected, and it is likely that the route of infection is sometimes via the vagina and fallopian tubes. • At other times, and always in males, the infection is blood-borne and secondary to respiratory tract or middle ear disease. Clinical Features • Onset is sudden, earliest symptom is pain localized to the lower half of the abdomen. • Temperature is raised to 39°C or more and there is usually frequent vomiting. • After 24–48 hours, profuse diarrhea is characteristic and increased frequency of micturition (caused by severe pelvic peritonitis) • On examination, abdominal rigidity is usually bilateral but is less than in most cases of acute appendicitis with peritonitis. Diagnosis • WBC count ≥ 30 000/μL with approximately 90% polymorphs suggests pneumococcal peritonitis rather than appendicitis Treatment • Antibiotic therapy + Correcting dehydration and electrolyte imbalance + Early surgery • Laparotomy or laparoscopy may be used. • If the exudate be odourless and sticky, the diagnosis of pneumococcal peritonitis is practically certain