Rare Case of Acute Peritonitis by Perforation of an Appendicular Schistosomiasis at the CHU BSS in Kati

Perforation of a pseudo appendicular tumor of bilharzial origin (bilharzia) is a rare etiology of acute peritonitis. His diagnosis is histopathological. The ex-istence of comorbid malaria and surgical pathology is frequent in having a positive thick drop with Schistosoma mansoni eggs in his stool. After 3 months, the patient is doing well. In conclusion, we recommend the histopathological analysis of the surgical specimen after appendectomy and the de-tection of haematozoa for malaria in any case of fever in a surgical environment.


Introduction
Abdominal-surgical emergencies are dominated in Africa particularly in the south of the Sahara by acute peritonitis [1]. Among these, appendicular and ileal perforations of typhoid origin are the most frequent [2] [3]. However, perforation of appendicular bilharzia in the free peritoneum causing acute peritonitis is an entity rarely cited in the literature. Peritonitis is defined as an acute inflammation of the peritoneum, localized or generalized, the cause of which is most often infectious. Not taken care of in a short time, local complications then generally occur and threaten the life of the patient. Peritonitis is divided into three groups according to the Hamburg classification according to the origin of the infection: -Primary peritonitis: These are due to a spontaneous mono-bacterial infection of the peritoneum of hematogenous origin or by translocation. Their treatment is medical. The most common causes are ascites infection with Escherichia coli in cirrhotic patients, staphylococcal infection via the catheter in patients with peritoneal dialysis and spontaneous pneumococcal peritonitis in adults.
-Secondary peritonitis represents 90% of peritonitis. They are linked to the spread of a localized abdominal infection or the perforation of digestive viscera.
The main causes are dominated by appendicular perforations, typhoid, gastric ulcers and diverticular perforations. These secondary peritonitis are associated with postoperative peritonitis by anastomotic laceration or by fistula.
-Tertiary peritonitis corresponds to persistent abdominal infections despite a well-conducted treatment (adapted antibiotic therapy and eradication of the primary abdominal focus by one or more interventions). The abdominal cavity is superinfected by microorganisms that are not very virulent but have become resistant or yeasts. These peritonitis are frequently associated with multiorgan failure syndrome.
Bilharzia is an old pathology whose first writings date back to 1500 BC in the Ebert papyrus. It is rampant in the tropics and subtropics in an endemic state and constitutes a real public health problem [4].
In Mali, it is the second most important parasitic disease [6] after malaria.
Two forms are present: the urogenital form due to Schistosoma haematobium (S. haematobium), the prevalence of which reaches 72%, and the intestinal form linked to Schistosoma mansoni (S. mansoni) 68% in certain areas of the country [7]. Appendicular schistosomiasis is a rare pathology, and exclusively for histopathological diagnosis [8] [9] [10]. We report a rare case of acute peritonitis by perforation of an appendicular pseudotumor of bilharzia origin (bilharzia) in the general surgery department of the CHU BSS in Kati.

Observation
It was a 19-year-old male patient, a shepherd by profession, weighing 52 kilograms, living in a rural area. He said he frequently bathes in the water reservoirs of micro dams in their area. He was urgently admitted to the CHU BSS in Kati for painful abdominal distension with fever of 39˚C and vomiting of food.
Symptoms began 4 days earlier in the right iliac fossa following dysenteriform, bloody diarrhea. In his history, the patient reported having resolving episodic chronic pain in the right iliac fossa with saddles often streaked with blood for more than six months. On clinical examination he presented with painful abdominal distension, motionless, with cry of the umbilicus, dullness of wood and disappearance of prehepatic dullness. On digital rectal examination the Douglas

Discussion
Acute peritonitis by appendicular perforation is the leading cause of peritonitis in Africa. It is followed by typhoid perforation peritonitis [2] [3]. If appendicular perforations of bacterial origin are the best known, the fact remains that the parasites in this case schistosomiasis or bilharzia can also cause this kind of complication. In the patient's history, the notion of chronic pain in the right iliac fossa (RIF) deserves further investigation.
Schistosomiasis is rampant in the tropics and subtropics in an endemic way and constitutes a real public health problem [1]. In Mali, the entire country is affected by this disease [11] [12]. Turner was the first to report in 1909, the first appendicular localization of bilharzia in a series of autopsies [13]. His diagnosis is only pathological. According to the authors, in the African and Asian series [14] [15], bilharzia is rarely implicated in the genesis of appendicular inflammation. Its prevalence ranged from 0.2% to 2.9%. On the other hand, in Europe, appendicular schistosomiasis is exceptional and is seen mainly in subjects coming from endemic areas [16]. However in Mali, its prevalence appears to be sig-

Conclusion
Bilharz infestation of the ileocecal appendix can cause an appendicular pseudotumor. Its treatment is medico-surgical. The histopathological examination must be rigorous in front of any piece of appendectomy.

Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this paper.