Spontaneous bacterial peritonitis: reversible cause of deterioration in patients with cirrhosis

Spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites carries a mortality rate ranging from 50% to 90%. Eleven patients were diagnosed at The Royal Melbourne Hospital over a 25-year period. Fever was present in eight, abdominal pain in eight, rebound tenderness in six and pre-coma in four. In two, the peritonitis was silent. All five diagnosed by paracentesis survived, but the three patients first diagnosed at laparotomy died. The experience shows that SBP can be successfully treated with antibiotics. Because of the variable clinical features, a diagnostic paracentesis is recommended in all cirrhotic patients presenting with ascites.