2020 Volume 70 Issue 1 Pages 31-35
This case is of a male in his 70s who had been undergoing hemodialysis treatment for the past 17 years due to chronic renal failure. He had been receiving steroid treatment for organized pneumonia since April X. He was diagnosed with pneumocystis pneumonia in June and underwent inpatient hospital care. He experienced sudden fever and abdominal distension in July, and since CT confirmed intraabdominal free air and ascites, the absence of gastrointestinal perforation could not be ruled out, and surgery was performed. However, no gastrointestinal perforations were found, despite careful examination; hence, the surgery was completed after cleaning and drainage of the abdominal area. The patient showed signs of improvement, but his symptoms reappeared 19 days after surgery, which were ameliorated with antibiotic treatment. Elimination of pneumoperitoneum was finally confirmed 49 days after surgery. Because the ascites cultures at both, the time of surgery and reappearance of symptoms tested positive in our case, we suspect that ascites can potentially cause bacterial peritonitis as a secondary disease. In conclusion, antibiotic treatment during both, surgical and conservative intervention is desirable for the management of idiopathic pneumoperitoneum.
