[Spontaneous bacterial peritonitis in a patient with decompensated alcoholic cirrhosis of the liver]

Spontaneous bacterial peritonitis (SBP) constitute a rare complication of cirrhosis of the liver with a high mortality rate. Unspecific sings of decompensation like increasing elaboration of ascites or the development of hepatic encephalopathy are often prevailing. Fever and peripheral blood leukocytosis as well as abdominal sings of peritonitis are not rarely completely missing. There is a strong suspicion of SBP with an ascitic polymorphonuclear count of greater than 500/mm3. Determination of lactate and pH in the ascitic fluid can increase diagnostic sensitivity and specificity if the leukocyte count is dubious. Gram negative rods predominate with over 70% whereas anaerobic organisms appear to be very rare. A 49 year old patient is presented and diagnostic and therapeutic strategies reviewed. In view of the high mortality every clinical deterioration of patients with cirrhosis should alert the physician of the presence of SBP.