Reiter's syndrome and recurrent peritonitis after appendectomy.

A 15-year-old male adolescent underwent an appendectomy for acute gangrenous appendicitis. One week after surgery, he underwent an exploratory laparotomy that revealed two pericecal abscesses, which were drained. Two weeks later, he had diffuse peritonitis and underwent another laparotomy, which revealed a sterile fibrinous peritonitis. Oligoarticular inflammatory arthritis, urethritis, and recurrent peritonitis subsequently developed. He was found to be positive for HLA-B27 antigens. This case report illustrates that reactive arthritis (Reiter's syndrome) may develop after peritoneal infections. It also raises the possibility that the inflammatory process, which involves other serosal surfaces in Reiter's syndrome, may affect the peritoneum.