Five instances of spontaneous peritonitis and bacteremia caused by enteric organisms have been observed in decompensated cirrhotic patients at this hospital during the past 5 years. The remarkable similarity of the clinical picture in these patients suggested that it represented a sharply defined syndrome (Table 1).
In each instance it started abruptly with sudden fever and shaking chills, accompanied by nausea, vomiting, and progressive abdominal discomfort. Hypotension, which was present in each patient, was usually severe. There was rapid deterioration in mental state characterized by confusion, disorientation, delirium, and asterixis. Although blood ammonia levels tended to increase, there was no