[Spontaneous bacterial peritonitis without ascites]

A 34-year-old woman with acute pain in the lower abdomen and a history of non-A-non-B-hepatitis underwent laparotomy. A diffuse light redness of the small bowel without ascites was the only abnormal finding. An appendectomy was performed. The patient deteriorated into a sepsis during the next 60 hours. Relaparotomy established acute diffuse peritonitis with ascites and without any apparent intra-abdominal source of infection. Tracheal, blood, and intraperitoneal cultures of both procedures grew group A streptococci and proved a haematogenous spread of the infection. The sepsis was successfully treated with antibiotics and peritoneal lavage. The course of the infection and the findings are discussed and the case is interpreted as a spontaneous bacterial peritonitis without ascites.