Spontaneous peritonitis: a reappraisal.

Spontaneous bacterial peritonitis occurs frequently in cirrhotic patients. In order to define more accurately the spectrum of this disease, 55 cases of spontaneous peritonitis were compared with 56 controls (patients with negative ascitic fluid cultures). Of several presenting symptoms, only vomiting (p less than 0.01), fever (p less than 0.05), and severe gastrointestinal bleeding (p less than 0.05) were more prevalent in cases than controls. There were no physical signs and no laboratory studies that separated the two groups except for elevated serum amylases in controls. Studies of peritoneal fluid were rarely helpful and cell counts overlapped in the cases and controls. Spontaneous peritonitis is usually seen in patients with severe liver disease, but there are few distinctive symptoms, signs, or laboratory findings. The mortality rate is high, and it is uncertain from our data that antibiotic therapy alters this prognosis.