Fortunate indeed is the surgical service that does not have one or more problem cases of recurrent marginal ulceration despite the adequacy of the surgical attack. These un fortunate few not only harass the individual surgeon but tend to humble those who ad vocate a so-called ideal surgical procedure for the control of the acid-peptic factor. On rare occasions repeated gastric resections, At the time this paper was published, Drs. Zol linger and Ellison were affiliated with the De partment

Fortunate indeed is the surgical service that does not have one or more problem cases of recurrent marginal ulceration despite the adequacy of the surgical attack. These un fortunate few not only harass the individual surgeon but tend to humble those who ad vocate a so-called ideal surgical procedure for the control of the acid-peptic factor. On rare occasions repeated gastric resections, At the time this paper was published, Drs. Zol linger and Ellison were affiliated with the De partment

No abstract

No abstract

Primary peritonitis, rarely diagnosed preoperatively, is an uncommon disease accounting for 2.1% of all pediatric abdominal emergencies. It is often associated with urinary or hepatic pathology, the former the source of the infecting organism in the majority of cases, and presents with characteristic symptoms depending upon whether it occurs in infancy or childhood. The symptoms and signs which allow for a positive prospective diagnosis are illustrated by comparing this disease to those entities with which it is most often confused, e.g. diffuse peritonitis of other etiologies, and include a short duration of symptoms, associated urinary tract infection and an absence of free air on abdominal roentgenograms. In the past, gram positive organisms were the most common infecting agent; however, in this series gram negative bacteria accounted for 69% or the organisms. Antibiotics with a gram negative spectrum and exploratory laparotomy with appendectomy are the hallmarks of therapy, the latter replaced by abdominal tap only in the patient who satisfies the criteria for primary peritonitis and in whom an associated disease makes the risk of surgery prohibitive.