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Bacterial peritonitis following esophageal injection sclerotherapy for variceal hemorrhage
1Department of Medicine, University of California, Davis Medical Center, Sacramento 95817.
Abstract:
Patients presenting with ascites and upper gastrointestinal hemorrhage were studied prospectively. Five patients presenting with acute variceal hemorrhage were found not to have pre-existing spontaneous bacterial peritonitis on initial paracentesis. However, three of these five developed findings compatible with bacterial peritonitis after sclerotherapy. Although the number of cases is small, our results support the monitoring of ascitic fluid after sclerotherapy.
Insights
Patients with ascites and upper gastrointestinal bleeding undergoing sclerotherapy require monitoring for bacterial peritonitis. Three of five patients developed peritonitis post-procedure, indicating a need for vigilant ascitic fluid analysis.
Area of Science:
- Gastroenterology
- Hepatology
- Infectious Diseases
Background:
- Ascites and upper gastrointestinal hemorrhage are common complications in patients with liver disease.
- Spontaneous bacterial peritonitis (SBP) is a serious infection associated with ascites.
- Esophageal varices are a frequent cause of upper gastrointestinal bleeding in cirrhotic patients.
Observation:
- A prospective study was conducted on patients with ascites and upper gastrointestinal hemorrhage.
- Five patients with acute variceal hemorrhage were initially assessed for spontaneous bacterial peritonitis (SBP) via paracentesis.
- None of these five patients presented with pre-existing SBP.
Findings:
- Three out of the five studied patients developed clinical findings suggestive of bacterial peritonitis following endoscopic sclerotherapy.
- The development of peritonitis occurred after the sclerotherapy procedure.
Implications:
- The findings suggest a potential link between endoscopic sclerotherapy and the development of bacterial peritonitis in patients with ascites.
- Close monitoring of ascitic fluid is recommended after sclerotherapy in this patient population.
- Further research with larger cohorts is warranted to confirm these observations and elucidate the underlying mechanisms.