A 40 year old male with advanced liver disease comes into the emergency room complaining of acute abdominal pain, fever, nausea, vomiting, and constipation. When he moves, the pain becomes more severe. Physical exam reveals dyspnea, diffuse abdominal rebound. amd abdominal rigidity. There is also abdominal hyper-resonance to percussion and ascites.
Labs: Gram negative rods found on blood agar plates containing kanamycin and vancomycin.
Discussion: The diagnosis of peritonitis is made by clinical presentation. The causative agent is determined by labs. Primary peritonitis is spontaneous and may result from ascites associated with cirrhosis or nephrotic syndrome. Peritonitis may also be secondary such as following abdominal trauma.
For more information on Bacteroides fragilis, please click here.