POSTOPERATIVE FUNGAL PERITONITIS: A REPORT OF TWO CASES

Fungal peritonitis, though rare, but presents a significant medical and social challenge due to its high complication rate and mortality, reaching 30%. The incidence of fungal infections in abdominal surgery, particularly postoperative peritonitis, is increasing, posing diagnostic difficulties and resulting in poor treatment outcomes.The aim of the study was to investigate the clinical characteristics of postoperative fungal peritonitis.Materials and methods. We conducted a literature review and present two clinical cases of confirmed postoperative fungal peritonitis. Case 1 involved a 52-year-old male with a left subdiaphragmatic abscess following splenectomy for traumatic splenic rupture. Case 2 involved a 64-year-old male with generalized peritonitis after surgery for a perforated duodenal ulcer. We retrospectively analyzed patient medical records, including laboratory results, imaging studies, surgical reports, treatment protocols, and outcomes.Results. Both patients exhibited stable hemodynamics, moderate abdominal pain, absence of abdominal wall rigidity, a questionable Blumberg sign, and subfebrile temperatures. Leukocyte counts (8.2x10^9/L and 9.8x10^9/L) and neutrophil differentials (8% bands and 60% segmented; 2% myelocytes, 9% bands, 53% segmented) showed minimal elevation. Biochemical profiles were within normal limits for the subdiaphragmatic abscess case, while the generalized peritonitis case showed mild abnormalities (total protein 59 g/L, urea 9.2 mmol/L, creatinine 110 μmol/L, total bilirubin 23 μmol/L) that did not definitively confirm peritonitis. Imaging revealed increasing free fluid in both cases. Comorbidity was identified as a risk factor in both cases. Clinical presentation was subtle, and standard laboratory markers were inconclusive. Imaging significantly enhanced diagnostic accuracy. The final diagnosis was verified only after microbiological examination.Conclusions. Comorbidities predispose to postoperative fungal peritonitis. The nonspecific clinical, laboratory, and imaging findings result in delayed diagnosis and treatment. Definitive diagnosis relies on microbiological confirmation.