Abdominal tenderness in ascites patients indicates spontaneous bacterial peritonitis

Research output: Contribution to journalArticle


Background: Spontaneous bacterial peritonitis (SBP), which has been reported to be present in 10-30% of patients with cirrhotic ascites, may easily be overlooked. An important aim of our study was to determine whether there are any clinical signs which, in clinical practice, may predict or exclude SBP. Methods: We studied 133 patients with cirrhotic ascites from medical units at nine Swedish university hospitals where there had been at least one diagnostic ascites tap with analysis of polymorphonuclear leukocytes in the ascites fluid. The patients had initially been questioned about background factors and physically examined according to a standardized case record form. Samples of blood, urine, and ascites were then drawn for analysis according to a structured schedule. Results: SBP could be excluded in 80% of all the cases and was confirmed in 8% of the 133 patients in the final analysis. Abdominal pain and abdominal tenderness were more common in patients with SBP (p<0.01), but no other physical sign or laboratory test could separate SBP cases from the others. Conclusions: SBP was present in about one-tenth of the hospitalized patients with cirrhotic ascites in this cohort. Performing repeated physical examinations and paying particular attention to abdominal tenderness may be the best way to become aware of the possible development of this complication. (C) 2006 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.


  • Sven Wallerstedt
  • Rolf Olsson
  • Magnus Simren
  • Ulrika Broome
  • Staffan Wahlin
  • Lars Loof
  • Rolf Hultcrantz
  • Klas Sjöberg
  • Hanna Sandberg Gertzen
  • Hanne Prytz
  • Sven Almer
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Family Medicine


  • spontaneous bacterial peritonitis, signs, cirrhosis, diagnosis, symptoms
Original languageEnglish
Pages (from-to)44-47
JournalEuropean Journal of Internal Medicine
Issue number1
Publication statusPublished - 2007
Publication categoryResearch