Radiologymovies - SPONTANEOUS BACTERIAL PERITONITIS

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VIDEO US : Loculated ascites : Intestinal loops appeared compressed , attached and displaced posteriorly. Normally , intestinal loops should be freely flowing.

VIDEO TC : Axial CECT in a cirrhotic patient with spontaneous bacterial peritonitis. Massive ascites displaced and clumped intestinal loops posteriorly.In May 2008 the patient was referred to other center for TIPS placement and liver and kidney transplantation.

CLINICAL CASES
PRESENTATION

A 47 year old man , born in Italy , was diagnosed with alcoholic cirrhosis in June 2007 on the basis of Hepatic decompensation with ascites.

There were no evidence of viral ( HBV HCV ) , autoimmune , metabolic or genetic liver disease.

Upper endoscopy showed oesophageal varices F2.

In September 2007 the patient developed refractory ascites and hepatorenal syndrome type II.

In January 2008 the patient was referred and was diagnosed alcoholic cirrhosis with organic renal failure with anuria and Hepato–renal syndrome type II, Child–Pugh C 10 , and MELD 28 , with indication for liver and kidney transplantation.

He underwent periodic haemodialisys ( 3 times / wk till now ) and large volume paracentesis with albumin reinfusion and was done valutation for liver and kidney transplantation.

In April 2008 there was Sonographyc and TC evidence of multilocular ascites and infection of ascetic fluid with showed Enterococcus Faecalis resitant to Cefotaxime , Sulbactam plus Ampicillin and response to Imipenem.

FINAL DIAGNOSIS :

SPONTANEOUS BACTERIAL PERITONITIS

DISCUSSION

Spontaneous Bacterial peritonitis is a severe complication of cirrhosis due to spontaneous bacterial infection of ascitic fluid.

The cause is due to an increased bowel permeability with consequent bacterial translocation from the intestinal lumen to the peritoneum.

Most frequently the infection is caused by Gram negative aerobic bacteria, less frequently gram positive or anaerobic.

Diagnosis: PMN count in ascitic fluid greater than 250/mm 3 . Colture of ascitic fluid can let to isolate the specific bacteria.

Therapy: first choice is Third generation Cephalosporins.

Survival at 1 year after an episode of SBP is less than 40%.

REFFERENCES :

Saadeh S, Davis GL. Management of ascites in patients with end-stage liver disease. Rev Gastroenterol Disord . Fall 2004;4(4):175-85

Gilbert JA, Kamath PS. Spontaneous bacterial peritonitis: an update. Mayo Clin Proc . Apr 1995;70(4):365-70

Bert F, Noussair L, Lambert-Zechovsky N, et al. Viridans group streptococci: an underestimated cause of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Eur J Gastroenterol Hepatol . Sep 2005;17(9):929–33

SPONTANEOUS BACTERIAL PERITONITIS

Autori:
D.Sirigu* M.R.Piras** ; T.Zolfino**;
*Radiologia A.O. Brotzu Cagliari ** Gastroentrologia A.O.Brotzu Cagliari

Agosto 2008
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E-mail: info@radmovies.it

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>SPONTANEOUS BACTERIAL PERITONITIS