Vasculitic small bowel perforation masquerading as spontaneous bacterial peritonitis in a patient with decompensated liver disease

We report on a young patient with decompensated alcohol-induced liver disea se (Child-Pugh score C) who presented with clinical, biochemical and radiol ogical evidence suggestive of spontaneous bacterial peritonitis, She was ho wever subsequently found to have multiple small bowel perforations, which w ere diagnosed only at laparotomy. The histology of the bowel showed evidenc e of vasculitis, This case illustrates two important points. Firstly, even if a patient has all the prerequisites to develop spontaneous bacterial per itonitis, a secondary cause of peritonitis (eg. bower perforation or intra- abdominal abscess) must always be considered as a differential diagnosis an d a repeat ascitic tap is mandatory after 48 h of antibiotic therapy to con firm a decrease in the white cell count. Secondly, it shows the rare cc-exi stence of alcoholic liver disease and vasculitis, Eur J Gastroenterol Hepat ol 11:459-461 (C) 1999 Lippincott Williams & Wilkins.