Spontaneous Bacterial Peritonitis Complicated by Loculations Requiring Alteplase

The state of healthcare is consistently being driven towards evidence-based practices to establish both optimal and consistent healthcare for all patients. From this evidence, treatment guidelines arise to meet these goals. As new data, diseases, and treatments develop, these guidelines that influence evidence-based practice are refined and redefined. However, while we have come far to understand the human body, there remain gaps in our knowledge and in the guidelines we rely on to treat our patients. We present a case of a patient with a common presentation but a rare finding where the guidelines have not yet been defined due to a lack of data. We describe a case of spontaneous bacterial peritonitis complicated by loculated ascites leading to hospital readmission. Of the patient's two loculated collections, only one of the two nearly resolved with clearance of loculations. That collection was treated with drain placement and alteplase dwells. There has been no analysis into whether this potential treatment may improve outcomes, but there are limited cases suggesting its possible benefit.