Secondary peritonitis associated with violation of the peritoneal cavity in cirrhotic patients decompensated by ascites: an under-discussed condition

Abstract

Introduction: Infectious peritonitis in decompensated cirrhotic patients with ascites results in high morbidity and mortality. While spontaneous bacterial peritonitis and peritonitis secondary to per­foration of hollow viscera have been well discussed and present well-defined diagnostic and treat­ment strategies, peritonitis secondary to violation of the peritoneal cavity, has been poorly studied. Objectives: Identify and describe a group of cirrhotic patients with secondary peritonitis associated with violation of the peritoneal cavity. Methods: A retrospective observational study conducted on cirrhotic patients with ascites, with a polymorphonuclear count greater than 250 cells/mm3 in the ascitic fluid and a record of abdominal or pelvic wall wound, with ascitic fluid leakage for more than 24 hours, preceding the diagnosis of peritonitis. Results: Secondary peritonitis associated with peri­toneal cavity violation was observed in 4.25% (10 cases/235 admissions) of the total admissions and 24.4% of the total peritonitis (10 cases out of 45 cases). Most wounds that led to peritonitis were related to complications from umbilical hernias (07/10). The treatment proved to be challenging, with the need to change antibiotic therapy in 70% of the cases. Conclusion: Secondary peritonitis asso­ciated with violation of the peritoneal cavity corresponded to a quarter of the cases of peritonitis in cirrhotic patients with ascites treated by a referral service. Further studies are needed to help improve diagnostic, treatment and possible prophylaxis strategies.