PERFORATION PERITONITIS: A CASE STUDY.

Peritonitis is an emergency health condition that is life-threatening and requires urgent surgery. here we presented a case of perforation peritonitis for a 21 years old male. The patient suffered severe abdominal pain constant vomiting of what he eat, not bloody diarrhoea and he had moderate fever. Abdomen examination showed peritonitis. And the CT.abdomen examination showed a presence of peritonitis and few air pocket in rectosigmoid region and posterior to pancrease which mean that patient had peritonitis with pneumoperitoneum. The patient underwent surgery and stayed in the hospital for 7 days during which the patient's health improved and became healthy.

Abdomen examination showed that there was board rigidity of abdomen, tenderness and rebound tenderness all over the abdomen but mainly at lower part. Diagnosis was Peritonitis (due to perforated ruptured viscus) . CT.abdomen examination showed : -Large abdominal and pelvic collection with thick enhanced peritoneum represent peritonitis.
-Few air pocket seen in rectosigmoid region and posterior to pancrease -Appendix is normal and other abdomen is unremarkable.
-Diagnosed as peritonitis with pneumoperitoneum The patient did ASCA test and it was positive. Operative findings showed -1000 ml of pus, pyogenic membranes covering all small bowel.   After the surgery was performed for the patient and necessary work was done for him, the patient stayed 7 days in the hospital, the patient showed improvement and the results of his investigations were normal. And he can eat and can defecate normally, the sound of his intestines was normal.

Discussion:-
Perforation peritonitis is considered as one of the most common surgical emergencies. In the tropical countries, the perforation peritonitis is usually seen in a younger age group as compared to the studies in the West (5). At the current study we presented a case for a 21 years old male with Peritonitis.
Our patient here had severe pain mainly at bilateral loins and suprapubic areas, constant vomiting of what he eat, not bloody diarrhoea and he had moderate fever. Local findings of our patient were board rigidity of abdomen, tenderness and rebound tenderness all over the abdomen but mainly at lower part. Commonly, peritonitis presents as an acute abdomen. Regarding the Local findings of peritonitis its include; abdominal tenderness, rigidity or guarding, diminished bowel sounds and distension. while, systemic findings include; fever, rigor or chills, sweating, dehydration, tachycardia, tachypnea, disorientation, restlessness, oliguria and shock in the end (6).
Based on a CT scan of the patient's abdomen, it showed a presence of peritonitis and few air pocket in rectosigmoid region and posterior to pancrease which mean that patient had peritonitis with pneumoperitoneum. Generalized peritonitis could result from gastrointestinal perforation, and it is among the most common reasons of intraperitoneal free air, the detection of these perforation is serious for diagnosis of life-threatening conditions among patients with acute abdomen (7). Many reasons could cause gastrointestinal tract perforations such as; peptic ulcer, blunt or penetrating trauma, inflammatory disease, a neoplasm or foreign body, and iatrogenic factors. Most of gastrointestinal perforations are emergency conditions which need an early recognition and urgent surgical treatment (7).
At the present study ASCA test revealed that our patient had a Crohn's disease. Crohn's disease is a chronic transmural inflammatory disease of the gastrointestinal tract. this disease is an idiopathic and very insidious, affecting any part gastrointestinal tract from mouth to anus, but mostly it's affecting small bowel and colon. Crohn's disease occurring mostly in the second to third decade of life, but in smaller rate during the sixth decade. Free intestinal perforation with diffuse peritonitis and free air on imaging is a very rare condition but likely lifethreatening complication of Crohn's disease that require urgent surgical management (8). in adults ranges between 1 and 2% (8). In 1932 was the first description of Crohn's disease since then almost100 cases of free intestinal perforation have been reported in adults (8).
In the present study, the patient underwent surgical treatment. Generally, the surgical practice for peritonitis due to perforation in the hollow viscera aims to eliminating the cause of the contamination, decreasing the bacterial inoculum, and preventing recurrent or persistent sepsis (10).

Conclusion:-
Peritonitis is an emergency health condition that is life-threatening and requires urgent surgery. Generalized peritonitis could result from gastrointestinal perforation, and it is among the most common reasons of intraperitoneal free air, the detection of these perforation is serious for diagnosis of life-threatening conditions among patients with acute abdomen. Free intestinal perforation with diffuse peritonitis and free air is likely life-threatening complication of Crohn's disease.