A Case of Spontaneous Bacterial Peritonitis without Liver Cirrhosis or Nephrotic Syndrome

Kenji Numa, Fumio Nagata, Akira Kanesiro

Department of Surgery, Kyoto Miniren Central Hospital

A 59-year-old man who had been undergoing maintenance hemodialysis for chronic renal failure was admitted to our hospital with broncopneumonia. During his hospitalization, he complained of lower abdominal pain and he was referred to the surgical department. On physical examination the abdomen was found to be slightly distended and a fluid wave was present. There was generalized abdominal tenderness with maximum tenderness at McBerney's point. Also there was rebound tenderness in all quadrants. Digital examination revealed a severe tenderness in Douglas's pouch. The white blood cell count was 12,600, and a pre-operative diagnosis of acute appendicitis with peritonitis was made. On opening the abdoninal cavity a large amount of contaminated fluid was encountered but there was no pronounced inflamation of the intestines nor evidence of perforation. Escherichia coli was detected by culture of the ascitic fluid. Spontaneous bacterial peritonitis is an infection of the ascitic fluid of patients who, in general, have liver cirrhosis or nephrotic syndrome. However, we encountered a case of spontaneous bacterial peritonitis without liver cirrhsis or nephrotic syndrome.

Key words
spontaneous bacterial peritonitis, chronic renal failure

Reprint requests
Kenji Numa First Department of Surgery, Shiga University School of Medicine
Tsukinowa-cho, Seta, Ohtsu, 520-21 JAPAN

Accepted
July 6, 1992

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