To the Editor.—
A recent article by Woelfel and Hansbrough described a 63-year-old man with spontaneous bacterial peritonitis and pneumoperitoneum (1983;249:921). My surgical colleague (Arthur R. Marks, MD, of Fairfield, Ill) and I have recently seen a similar case.
Report of a Case.—
A 55-year-old man was admitted to Fairfield Memorial Hospital on June 22, 1982, with complaints of abdominal pain of two days' duration associated with "chills" but no fever. He had undergone resection of adenocarcinoma of the colon in August 1981. Sigmoidoscopy and air-contrast study of the colon were done in March 1982 and showed no evidence of recurrence and no intraperitoneal air.The abdominal examination on admission showed active bowel sounds and diffuse tenderness to palpation but no rebound tenderness. Roentgenograms of the abdomen taken when the patient was upright showed subdiaphragmatic intraperitoneal gas above the dome of the liver. On complete blood cell count, he had