Zafar Muhammad Usman, Marjara Jasraj, Tarar Zahid Ijaz, Ghous Ghulam, Patel Preysi
Hospital Medicine, Lehigh Valley Health Network, Allentown, USA.
Internal Medicine, University of Missouri, Columbia, USA.
Cureus. 2020 Oct 16;12(10):e10995. doi: 10.7759/cureus.10995.
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.
腹水最常见的病因是肝硬化。其他病因，如心力衰竭、癌症和胰腺炎等，也可引发这种异常情况。自发性细菌性腹膜炎（SBP）是腹水的一种感染，发生时无任何腹腔内可手术治疗病因的证据。心源性感腹水也可并发SBP。在此，我们报告一例62岁男性患者，他有广泛的心脏病史，因持续呼吸困难和端坐呼吸前来就诊。他还伴有明显的腹胀和凹陷性水肿。该患者被诊断为缩窄性心包炎，并因心包切除术入院。腹水符合漏出液过程。实验室检查和影像学检查未显示肝脏或肾脏疾病的证据。腹水提示为心源性感腹水。术后患者起初出现间歇性发热，最初认为是心包炎所致，但后来发现是SBP使其复发性腹水复杂化。心包切除术后SBP使腹水复杂化的这种时间关联在文献中尚未被频繁讨论。
