CT scan revealed large amounts of intra-abdominal fluid, but no infectious focus could be detected.
Purulent ascites was retrieved by ultrasound guided abdominal
paracentesis. Antibiotic therapy with piperacillin and tazobactam
was initiated and since secondary peritonitis was suspected, the
patient was taken to the operating room. Laparotomy confirmed
fibrinous purulent peritonitis, but no obvious source of infection
could be identified. Blood cultures and ascites culture showed
gram-positive cocci, which were further characterized as GAS. During
the following weeks, multiple laparotomies were necessary and
eventually a Hartmann’s procedure was performed for ischemia
of the sigmoid colon. 56 days after the first operation, the patient
could be discharged. Gastrointestinal continuity was restored eight
months thereafter. The source of GAS infection remained unclear.