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February 18, 1983

Spontaneous Bacterial Peritonitis and Pneumoperitoneum: A False Surgical Emergency

Author Affiliations

From the Department of Surgery, the University of Colorado Medical School, Denver.

JAMA. 1983;249(7):921-922. doi:10.1001/jama.1983.03330310051026

THE radiological finding of free air within the peritoneal cavity is usually evidence of disease or injury and is best treated by surgical exploration. Spontaneous or primary bacterial peritonitis is a bacterial infection of the peritoneum not associated with underlying surgical disease. Perforated ulcer or intestine, abscess, or penetrating abdominal wound are not factors present as the underlying cause. Spontaneous bacterial peritonitis (SBP) is commonly associated with underlying liver disease, usually cirrhosis with ascites, or the nephrotic syndrome.

We describe a patient with cirrhosis with gross ascites and renal failure, who had signs and symptoms of peritonitis and pneumoperitoneum on roentgenogram. At laparotomy, no evidence of gastrointestinal (GI) tract perforation was found. Ascitic fluid culture yielded Clostridium perfringens, suggesting a diagnosis of SBP.

Report of a Case  A 63-year-old man with a long-standing history of alcohol abuse was admitted to the hospital in September 1980 with increasing abdominal girth, increasing