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 w ith acute jejunitis in a 52-year-old homeless Child-Pugh C cirrhotic man wi thout ascitis. The patient was admitted with clinical signs of peritonitis, and jaundice. Morphologic examination was unremarkable. A laparotomy revea led a diffuse peritonitis, and an acute jejunitis with prenecrotic lesion. The lesion was located within the first centimeters of the jejunum, immedia tely after the duodeno-jejunal angle, extented on 15cm. A resection of the first 15cm of the jejunum was performed with duodeno-jejunal side-to-side m anual anastomosis. Gram-stain and cultures of blood, peritoneal pus, and je junal mucosa revealed a penicillin-sensitive Streptococcus pneumoniae. Appr opriate parenteral antibiotic treatment was initiated (aminopenicillin). Th e 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 cirrhoti c patients.