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Presents as a patient with ascites and general deterioration. On clinical examination, peritoneal irritation is not very pronounced and the diagnosis is made by means of a puncture of the ascitic fluid. This ascitic fluid is cloudy, rich in cells and contains leukocytes: > 500/mm2, of which > 250/mm2 granulocytes. Culture of the ascitic fluid yields, among other things, E.coli. If various pathogenic bacteria are present in the ascitic fluid, this may indicate secondary bacterial peritonitis (including a perforated appendix).

If cytosis is present in the ascitic fluid, antibiotics must be started immediately, for example a third-generation cephalosporin or quinolone. Afterwards, secondary prevention with peroral antibiotics (type quinolone) is necessary until the ascites disappears.

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