Bacterial peritonitis and sepsis presenting as acute gastrointestinal bleeding in patients with portal hypertension.

Four children with portal hypertension and ascites developed hematemesis, abdominal pain, and fever as the acute manifestations of bacterial peritonitis. Initial management in the emergency department was directed toward controlling the upper gastrointestinal hemorrhage, and antibiotic therapy was delayed in four of six episodes until ascitic fluid cultures grew Streptococcus pneumoniae. Gastrointestinal bleeding has not been previously reported as a presenting symptom of peritoneal infection. Our clinical experience emphasizes the need for antibiotic therapy during the initial management of children with ascites and hematemesis.