Spontaneous Bacterial Peritonitis in Cardiogenic Ascites

Abstract

The most common cause of ascites is liver cirrhosis. Additional causes such as heart failure, cancer, and pancreatitis among others can also precipitate this abnormality. Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid that happens without any evidence of an intra-abdominal surgically-treatable cause. Ascites of cardiac origin can also be complicated by SBP. Here we present a case of a 62-year-old male with extensive cardiac history who presented to our service with ongoing dyspnea and orthopnea. He also had significant abdominal distention and pitting edema. The patient was found to have constrictive pericarditis and was admitted for pericardiectomy. Ascitic fluid was consistent with a transudative process. Lab and imaging did not show evidence of liver or kidney disease. Ascitic fluid was indicative of ascites of cardiac origin. Postoperatively patient developed intermittent fevers initially thought to be due to pericarditis but later found to be due to SBP complicating his recurrent ascites. Such a temporal association of SBP that complicates ascites after pericardiectomy has not been discussed frequently in literature.

Constrictive Pericarditis with Cardiac Ascites Caused Spontaneous Bacterial Peritonitis

“…However, in the present case, SBP developed despite the absence of cirrhosis. Some reports have suggested that cardiogenic ascites with heart failure due to any type of heart disease (e.g., CP, ischemic heart disease, congenital heart disease, valvular heart disease, or arrhythmia) may be a possible cause of SBP, even in the absence of cirrhosis ( 5 , 7 - 10 ). In patients with heart failure, substantial hemodynamic changes, such as hypoperfusion and congestion in the intestines, can alter the gut morphology, permeability, and function and induce the growth of microbiota that may ultimately stimulate bacterial translocation and endotoxin release ( 5 , 11 , 12 ).…”

Cell-free and concentrated ascites reinfusion therapy for refractory massive cardiac ascites in an adult with single ventricle haemodynamics: a case report

“…Cardiac ascites, one of the classical right-sided heart failure (HF) findings mainly caused by tricuspid valve disease and constrictive pericarditis, only contributes to 5% of all ascites cases. 1 Although treatments with diuretics and nutritional therapy with sodium restriction are effective in controlling ascites, massive cardiac ascites observed in advanced HF is sometimes refractory to such non-invasive conventional therapies. Drainage of refractory cardiac ascites by abdominal paracentesis is an invasive conventional therapy that can alleviate patients’ symptoms; however, it often facilitates hypoproteinaemia due to protein loss, leading to malnutrition and renal dysfunction.…”