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Secondary vs Spontaneous Peritonitis — SCE Infectious Diseases MCQ

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HardHealthcare-Associated InfectionsSecondary vs Spontaneous PeritonitisSCE Infectious Diseases

A 50-year-old man with cirrhosis develops bacterial peritonitis after paracentesis (secondary peritonitis from inadvertent bowel perforation during the procedure). Ascitic fluid shows: WCC 5,000/µL (95% neutrophils), multiple organisms on Gram stain, and protein 35 g/L. How does this differ from SBP?

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Correct answer: C — Secondary peritonitis shows polymicrobial Gram stain, very high neutrophil count, high ascitic protein (>10 g/L), and often low glucose — CT abdomen is needed to identify the source

Distinguishing secondary peritonitis (bowel perforation, abscess) from SBP is critical because secondary peritonitis requires surgical intervention plus antibiotics, whereas SBP is managed medically. Runyon's criteria for suspected secondary peritonitis include: ≥2 of (glucose <2.8 mmol/L, protein >10 g/L, LDH > upper limit of normal serum), polymicrobial Gram stain/culture, and very high neutrophil count. CT abdomen should be performed urgently to identify the source (perforation, abscess). Broad-spectrum antibiotics and surgical consultation are needed.

Reference: EASL 2024 – Cirrhosis complications; BSG 2021 – Ascites