Spontaneous bacterial peritonitis

Peritonitis is the inflammation of the peritoneum, which lines the abdominal wall and most abdominal organs. We distinguish primary peritonitis (spontaneous bacterial peritonitis) and secondary peritonitis.

Spontaneous bacterial peritonitis is usually a monomicrobial infection, while secondary peritonitis is usually a polymicrobial infection. Secondary peritonitis may be generalised or local, while primary peritonitis is always generalised.

Peritonitis is a severe condition as it has a high risk of progressing to sepsis with high mortality. The underlying cause must be sought and treated.

Etiology

Spontaneous bacterial peritonitis is a disease of cirrhotic patients, as it almost exclusively occurs in patients with ascites due to cirrhosis, and not ascites due to other causes. The pathomechanism is not well known but involves bacterial translocation from the intestinal lumen to lymph nodes, from which the bacteria spread to the circulation, eventually colonising the ascitic fluid.

Clinical features

See the main topic of peritonitis.

Diagnosis and evaluation

Spontaneous bacterial peritonitis is diagnosed if the patient has peritonitis, cirrhosis and no surgically treatable intraabdominal source. Neutrophil count of > 250/µL in the ascitic fluid supports the diagnosis.

Treatment

The treatment of spontaneous bacterial peritonitis involves fluid resuscitation and empiric antibiotics, without surgery.