Introduction with a case
Secondary bacterial peritonitis
Red flags for secondary bacterial peritonitis
Significance of ultrasound showing septated ascitic fluid.
Conclusion of the case
- Secondary bacterial peritonitis should always be considered before making a diagnosis of spontaneous bacterial peritonitis.
- Red flags for secondary bacterial peritonitis:
- Frank peritoneal signs on physical examination
- Point-of-care ultrasonography showing free air
- Gram stain with multiple organisms
- Treatment failure
- Septations should not be seen in sterile ascitic fluid from cirrhosis. The presence of septations suggests infection, either primary or secondary bacterial peritonitis.
- When concerned regarding the possibility of secondary bacterial peritonitis, there should be a low threshold to obtain a CT scan.