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Pneumoperitoneum caused by spontaneous bacterial peritonitis: a case report
1Division of General Surgery, Taichung Veterans General Hospital, Taiwan, R.O.C.
Abstract:
Spontaneous bacterial peritonitis (SBP) rarely presents as pneumoperitoneum. Only four such cases have been reported in the English literature. This report concerns a 65 year-old male patient with SBP and pneumoperitoneum. He has had a history of peptic ulcer. However, upon examination, no associated diseases or compromised immunity was detected. He presented with acute abdominal pain and subphrenic free air. An emergency laparotomy was performed, under the impression of a perforated peptic ulcer. Yet, no intraabdominal pathology except 200 ml of purulent ascites was found. The ascites culture yielded E. coli, B. fragilis, and P. aeruginosa confirming the diagnosis of SBP. Antibiotics which are sensitive to gas-forming bacteria should be prescribed before the result of the ascites culture is known.
Insights
Spontaneous bacterial peritonitis (SBP) rarely causes pneumoperitoneum. This case highlights SBP diagnosis in a patient presenting with pneumoperitoneum, emphasizing prompt antibiotic treatment for gas-forming bacteria.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Case Reports
Background:
- Spontaneous bacterial peritonitis (SBP) is a serious infection in patients with ascites.
- Pneumoperitoneum, the presence of air in the abdominal cavity, is an uncommon presentation of SBP.
Observation:
- A 65-year-old male with a history of peptic ulcer presented with acute abdominal pain and subphrenic free air.
- Despite initial suspicion of perforated peptic ulcer, laparotomy revealed no perforation but 200 ml of purulent ascites.
Findings:
- Ascites culture identified E. coli, B. fragilis, and P. aeruginosa, confirming SBP.
- The patient had no other detected underlying diseases or compromised immunity.
Implications:
- This case underscores the rare presentation of SBP as pneumoperitoneum.
- Early administration of antibiotics effective against gas-forming bacteria is crucial, even before culture results are available.