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

Authors

  • Thiago Torezani Universidade Federal do Espírito Santo https://orcid.org/0000-0003-2354-9832
  • Caroline Alcure Pinto
  • Izabelle Venturini Signorelli
  • Luciana Lofêgo Gonçalves
  • Maria da Penha Zago-Gomes

DOI:

https://doi.org/10.47456/rbps.v25isupl_2.38972

Keywords:

Liver cirrhosis, Peritonitis, Ascites, Hernia

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.

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References

Runyon BA. Ascites and Spontaneous Bacterial Peritonitis. In: Schiff ER, Maddrey WC, Sorrell MF. Schiffs Disease of the Liver. 11th ed. Wiley-Blackwell; 2011; p. 393-419.

Conn HO. Spontaneous peritonitis and bacteremia in Laennec`s cirrhosis caused by enteric organisms: A relatively common but rarely recognized syndrome. Ann Intern Med. 1964;60(4):568-579.

Garcia-Tsao G. Spontaneous bacterial peritonitis: a historical perspective. J Hepatol. 2004;41(4):522-527.

Wiest R, Schoelmerich J. Secondary peritonitis in cirrhosis: “Oil in fire”. J Hepatol. 2010;52(1):7-9.

Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, Krag A, Laleman W, Gines P. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-460.

Runyon BA, Hoefs JC. Ascitic fluid analysis in the differentiation of spontaneous bacterial peritonitis from gastrointestinal tract perforation into ascitic fluid. Hepatology. 1984;4(3):447-450.

Akriviadis EA, Runyon BA. Utility of an algorithm in differenti¬ating spontaneous from secondary bacterial peritonitis. Gastro¬enterology. 1990;98(1):127-133.

Soriano G, Castellote J, Alvarez C, Girbau A, Gordillo J, Baliellas C, Casas M, Pons C, Román EM, Maisterra S, Xiol X, Guarner C. Secondary bacterial peritonitis in cirrhosis: a retrospective study of clinical and analytical characteristics, diagnosis and management. J Hepatol. 2010;52(1):39-44.

Ariza X, Castellote J, Lora-Tamayo J, Girbau A, Salord S, Rota R, Ariza J, Xiol X. Risk factors for resistance to ceftriaxone and its impact on mortality in community, healthcare and nosocomial spontaneous bacterial peritonitis. J Hepatol. 2012;56(4):825-832.

Piano S, Fasolato S, Salinas F, Romano A, Tonon M, Morando F, Cavallin M, Gola E, Sticca A, Loregian A, Palú G, Zanus G, Senzolo M, Burra P, Cillo U, Angeli P. The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis: results of a roandmized, controlled clinical trial. Hepatology. 2016;63(4):1299-1309

Rosenblatt R, Tafesh Z, Shen N, Cohen-Mekelburg S, Kumar S, Lucero C, Brown RS, Verna E, Fortune B, Jesudian A. Early para¬centesis in high-risk hospitalized patients: time for a new quality indicator. Am J Gastroenterol. 2019;114(12):1863-1869.

Mattos AA, Wiltgen D, Jotz RF, Dornelles CMR, Fernandes MV, Mattos AZ. Spontaneous bacterial peritonitis and extra¬peritoneal infections in patients with cirrhosis. Ann. Hepatol. 2020;19(5):451–457.

Tandon P, Garcia-Tsao G. Renal dysfunction is the most import¬ant independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. J Clin Gastroenterol. 2011;9(3):260-265.

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Published

2023-09-24

How to Cite

1.
Torezani T, Alcure Pinto C, Venturini Signorelli I, Lofêgo Gonçalves L, Zago-Gomes M da P. Secondary peritonitis associated with violation of the peritoneal cavity in cirrhotic patients decompensated by ascites: an under-discussed condition. RBPS [Internet]. 2023 Sep. 24 [cited 2025 Mar. 6];25(supl_2):10-7. Available from: https://periodicos.ufes.br/rbps/article/view/38972

Issue

Vol. 25 No. supl_2 (2023)

Section

Artigos Originais

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