BENIGN PAROXYSMAL PERITONITIS

Abstract

Five cases are presented illustrative of a clinical syndrome termed ''benign paroxysmal peritonitis.'' These patients suffered from attacks which began in the 2d or 3d decade of life and continued for from 5- to 25 yrs. The paroxysms were characterised by severe abdominal pain, fever from 100[degree] to 105[degree] F. and marked abdominal tenderness, both direct and rebound. In some episodes abdominal wall spasm was noted. Acute surgical lesions were frequently suspected. In 4 instances chest pain indicative of pleural or diaphragmatic irritation was present as an associated but not invariable symptom. In one case only, urticarial wheals were noted as often accompanying the paroxysm. Laparotomy performed in one case during the acute episode revealed only injn. of blood vessels of the peritoneum overlying small and large bowel in the lower abdominal cavity. Interval abdominal exploration was entirely negative in a 2d case. Appendectomy was performed in 3 cases. The available evidence suggests that the essential lesion is a reversible vascular reaction taking place particularly in the peritoneal subserosa. This unusual disorder, characterised by a distinctive clinical picture, appears related to the visceral erythemas and purpura and to certain forms of gastrointestinal food allergy. In the present series none of the cases could be shown to be due to food allergy although in 4 there was at least suggestive evidence of an allergic heredity. Further observation is necessary to estab -lish the etiologic and pathologic basis of this disease.