Abstract
A 37-year-old woman was admitted with epigastric pain. Her abdomen was distended, and there was rebound tenderness. Abdominal enhanced computed tomography confirmed a poor contrast region in the ileocecal region to the ascending colon and a large amount of ascites. An urgent laparotomy was performed for acute peritonitis caused by bowel necrosis. There was a large amount of purulent ascites at the time of surgery, intra-peritoneal drainage was performed, and antibiotic therapy with tazobactam/piperacillin was started. However, no causes of acute peritonitis, such as gastrointestinal perforation, were evident. On day 2 after the operation, Streptococcus pyogenes was detected from the culture of the intra-abdominal white coat. Primary peritonitis caused by Streptococcus pyogenes was diagnosed. Ceftriaxone and clindamycin were given to treat the Streptococcus pyogenes ; the patient's general condition improved, and the inflammatory reaction decreased. On postoperative day 19, the patient was discharged in good condition. Primary peritonitis with Streptococcus pyogenes is a cause of acute peritonitis. It should be suspected in a patient with no obvious cause of acute peritonitis during the operation.
