Abstract
A-79-year-old Japanese man with a history of atrial fibrillation and congestive heart failure was admitted for abdominal pain. Ultrasonography showed pelvic ascites and peritoneal irritation, or inflammatory change was seen in laboratory studies. After conservative therapy was begun, he was sent to us with peritoneal irritation and marked inflammatory deterioration. We suspected generalized peritonitis due to a perforated appendix, and conducted to emergency laparotomy. We found a swollen appendix and purulent ascites in the pelvis, and conducted an appendectomy. Bacteroides thetaiotaomicron was detected from ascites. Microscopic findings for the resected appendix showed severe serositis without mucosal inflammation. Because of elevated serum CEA and anemia, we conducted a gastrointestinal examination. Barium enema and colonoscopy showed advanced ascending colon cancer, necessitating right hemicolectomy with node dissection on postoperative day (POD) 23 after the appendectomy. The tumor showed neither perforation nor abscess. Histologically, the tumor was well-differentiated adenocarcinoma. The histological stage was ss, n (-), P0, H0, M (-), stage II. The postoperative course was uneventful and he was discharged on POD17 after the second surgery. We propose the mechanism of spontaneous bacterial peritonitis as follows. Ascites due to congestive heart failure was fol-lowed by bacterial translocation of Bacteroides in the necrotic tumor or edematous intestinal mucosa on the oral side of the colonic tumor, resulting in spontaneous bacterial peritonitis.
