Key result
Peritoneal-pericardial connection in decompensated cirrhosis linked to septic shock and multi-organ failure.
Spontaneous bacterial pericarditis with tamponade is a rare but severe complication of decompensated cirrhosis, with peritoneal-pericardial connections confirmable by nuclear scintigraphy.
Pericardial involvement warrants consideration in septic decompensated cirrhosis; this case report leaves open prevalence and optimal management.
We report a case of a 56-year-old male with alcohol-associated liver cirrhosis presenting with septic and obstructive shock due to spontaneous bacterial peritonitis and pericarditis with tamponade. Imaging revealed ascites, pleural and pericardial effusion requiring drainage. Escherichia coli with identical resistance patterns was cultured from all drained fluids. Scintigraphy confirmed a peritoneal-pericardial connection. After initial treatment, fluid recurrences prompted evaluation for transjugular intrahepatic portosystemic shunt (TIPS) placement, which was unfortunately complicated by severe bleeding, ultimately leading to multi-organ failure and death. This case highlights the exceptional occurrence of pericardial effusion and spontaneous bacterial pericarditis as well as peritonitis as a complication of decompensated cirrhosis, with confirmed connection between the pericardium and the abdominal cavity by nuclear tracer study, as well as microbiological evidence. Based on an overview of all published cases management includes diuretics, paracentesis and in refractory cases, TIPS. Liver transplantation remains the definitive treatment.
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Loocke et al. (2026) studied this question. A confirmed peritoneal-pericardial connection was identified in a patient with decompensated cirrhosis, leading to septic shock and complications including multi-organ failure.
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