Revista ABCd (São Paulo). 01 Jan, 2016


João Kleber de Almeida GENTILE
Maurice Youssef FRANCISS
Hamilton Ribeiro BRASIL
DOI: 10.1590/0102-6720201600010019


The meningococcal disease manifestation as acute abdomen with meningococcal peritonitis is rare. Is reported primary peritonitis and bacteremia by Neisseria meningitidis serotype C occurring in conjunction with the obstructive acute abdomen.


Man with 27 year old was admitted with diffuse abdominal pain accompanied by stop in eliminating flatus and feces for three days and fever 38,3º C for 24 h. As history, had passed prior laparotomy seven years ago for acute appendicitis. He denied other symptoms, recent travel or infectious diseases. There was no recent use of medications or hospitalization. Denied alcohol or illicit drugs.

On examination, he was confused, agitated, dehydrated with clinical signs of sepsis. Was febrile (38,3º C), with tachycardia (112 beats per minute), tachypnea (20 breaths per minute) and hypotension (90x50 mmHg). The abdomen had prior infraumbilical laparotomy scar, very distended, painful diffusely, hypertimpanic and positive to sudden decompression. There was no evidence or clinical signs of liver disease or ascites. Rectal touch was normal without bleeding or mucus in the stool.

Initial investigation showed leukocytosis (18,600 leukocytes with 11% rod cells), metabolic acidosis signals, high C-reactive protein (38.6 mg/l) and abdominal radiography with air-fluid levels without pneumoperitoneum. Abdominal CT scan showed only distension and small amount of free fluid in the abdominal cavity; urinalysis and electrolytes unchanged. Differential diagnoses were acute inflammatory abdomen with diffuse peritonitis and acute obstructive abdomen.

Patient received treatment with appropriate volume expansion 20 ml/kg and antibiotic therapy with ciprofloxacin 400 mg 12/12 h and metronidazole 500 mg 8/8 h. It was referred to explorative laparotomy as urgency after 24 h after admission.

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