Peritonitis Due to Ruptured Pyonephrosis: First Case Report in a Child and Management in Rural Chad in Africa

Pyonephrosis is a rare condition characterized by the destruction of renal parenchyma, which can lead to severe complications such as secondary peritonitis in cases of rupture. In this article, we report a rare case of acute peritonitis in a 12-year-old girl caused by ruptured pyonephrosis, occurring in a rural setting in Chad. The patient, with no prior medical history, was admitted for acute abdominal syndrome. She had experienced intermittent lumbar pain for six months, self-medicated without medical consultation. Radiological assessment revealed a markedly dilated right kidney with echogenic content suggestive of pyonephrosis overlying a renal calculus, along with abdominal fluid collection. A confirmatory CT scan could not be performed due to the unavailability of imaging facilities. Exploratory laparotomy revealed purulent intra-peritoneal fluid and a necrotic right kidney, necessitating nephrectomy. The patient recovered well postoperatively. Beyond its surgical relevance, this case highlights the urgent need for increased awareness regarding early medical consultation and improved access to advanced diagnostic tools in rural areas. To the best of our knowledge, this is the first reported case of pediatric peritonitis due to ruptured pyonephrosis managed entirely in a rural African setting.