Spontaneous bacterial peritonitis (SBP): Pathophysiology & Imaging features
1. What is spontaneous bacterial peritonitis
It is bacterial infection of the ascitic fluid and is primarily seen in cirrhotics, which have advanced liver failure. It happens in the absence of evident intra abdominal and surgically treatable source of infection like perforation etc. The common bacterial pathogen is E.Coli, streptococcus & Klebsiella.
2. Etiology " Bacterial Translocation (BT)"
It happens due to translocation of the gut bacteria into the ascitic fluid. It is probably due to weekend immune system, altered gut flora and inflammation of the bowel.
3. Clinical Presentation:
They may present with fever & chills, abdominal distension, abdominal pain, diarrhea or even with confusion. Due to sepsis they may also have organ dysfunction.
4. How to diagnose
Diagnosed by assessment of ascitic fluid. Positive ascitic fluid bacterial cultures and detection of an elevated absolute fluid polymorphonuclear neutrophil (PMN) count (> 250 mm 3)
5. Imaging features
Ascites with a hazy and dirty appearing mesentery. There may be other features like peritoneal thickening and enhancement.
Fig. 2: Image on left is same patient with ascitis. Image on the right is infected ascitis (SBP). Note the mesentery is hazy as compared to the left image
5. Management & prognosis
I.v antibiotics required for treatment. Since, it can happen repeatedly, patient may be kept on long term oral antibiotics.
References:
1. https://jamanetwork.com/journals/jama/fullarticle/2777471
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123576/
Prepared by Dr. Sharad Maheshwari
17.11.2022
Updated: 18.11.2022
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