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Does spontaneous bacterial peritonitis occur in malignant ascites?
Abstract:
Spontaneous bacterial peritonitis is a well-described entity estimated to occur in 8% of patients with cirrhotic ascites. Characteristic clinical findings may often be absent and the only manifestation may be decompensation of liver function. Ascites at Memorial Hospital is most commonly related to malignancy. We reviewed the records of 101 patients with ascitic fluid cytology positive for malignancy during the calendar year 1979. The most common malignant cytological diagnosis was adenocarcinoma, seen in 76 patients. Of the 101 patients with positive ascitic fluid cytology, 65 fluid specimens had microbiological studies performed which included aerobic, anerobic, fungal, and acid fast bacterial cultures. Only three patients had positive ascitic fluid cultures. We believe that these three patients had other reasons for peritonitis and do not represent true spontaneous bacterial peritonitis. Ascites alone, without liver disease, seem to predispose to spontaneous bacterial peritonitis. Perhaps, the presence of liver disease with less than normally effective hepatic reticuloendothelial function and portasystemic shunting is needed for the development of spontaneous bacterial peritonitis.
Insights
Spontaneous bacterial peritonitis (SBP) is rare in cirrhotic ascites patients with malignancy. Ascites alone, without liver disease, may increase SBP risk, suggesting liver disease is crucial for SBP development.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Oncology
Background:
- Spontaneous bacterial peritonitis (SBP) affects approximately 8% of patients with cirrhotic ascites.
- Clinical presentation of SBP can be subtle, often manifesting as liver function decompensation.
- Ascites at Memorial Hospital is frequently associated with malignancy.
Observation:
- A review of 101 patients with malignant ascites (cytology positive) was conducted.
- Adenocarcinoma was the most common malignant diagnosis (76 patients).
- Microbiological studies were performed on 65 ascitic fluid samples.
Findings:
- Only three patients had positive ascitic fluid cultures.
- These three cases were deemed unlikely to represent true SBP.
- Ascites without liver disease appears to be a potential risk factor for SBP.
Implications:
- Liver disease, with impaired reticuloendothelial function and portasystemic shunting, may be necessary for SBP development.
- Further research is needed to elucidate the precise role of liver disease in SBP pathogenesis.
- Distinguishing SBP from other causes of peritonitis in patients with ascites is clinically important.