The etiology of diffuse peritonitis in children differs from that usually seen later in life. The source of infection is frequently extra-abdominal; the attending sepsis so often dominates the clinical picture that the peritonitis may be temporarily overlooked. Metastatic peritonitis due to hemolytic streptococci is more common than is usually acknowledged. The individual physician does not often recognize the pathologic process early because of his limited experience with this entity. While this discussion is concerned primarily with streptococcic peritonitis in children, the forms which occur in adults are included to complete the study.
The diagnosis of the acute forms of peritonitis is difficult in childhood and more particularly in infancy. The reason lies in an inability to obtain an accurate subjective history, the difficulty in making a reliable physical examination and the frequency with which irregular complaints referable to the abdomen accompany infections of the upper respiratory tract, gastro-intestinal upsets