Diagnostic accuracy of a rapid urine-screening test (Multistix8SG) in cirrhotic patients with spontaneous bacterial peritonitis.

OBJECTIVE: To assess the diagnostic accuracy of a rapid urine-screening test (Multistix8SG) for spontaneous bacterial peritonitis (SBP) in cirrhotic patients. METHODS: Seventy-two consecutive patients (44 males, 28 females; mean age 61.6 years) with cirrhosis and ascites were included in the study. A diagnostic paracentesis was performed on hospital admission in all patients and 2 days after antibiotic treatment in the case of SBP (polymorphonuclear [PMN] count over 250/mm in ascitic fluid). Each fresh sample of ascitic fluid was also tested using the Multistix8SG urine test, and the results were scored as negative, trace or positive. RESULTS: Nine of the 72 patients had SBP and the Multistix8SG urine test was positive. After 48 h of antibiotic therapy, the PMN count of three of these nine patients was still above 250/mm and the Multistix8SG test remained positive. In three other patients with SBP, the PMN count dropped below 250/mm and the Multistix8SG test result had become negative. Two of the nine SBP patients died before 48 h, and paracentesis was not performed in the ninth case. In the other 63 patients, the PMN count in ascitic fluid was below 250/mm; the Multistix8SG test revealed 17 trace results and 46 negative results. At the threshold of 250 PMN/mm in ascitic fluid, this test had a sensitivity and a specificity of 100%. CONCLUSION: A positive Multistix8SG urine test result in ascitic fluid appears to be an indication for antibiotic treatment.

Diagnosis of postoperative urinary ascites using renal scintigraphy.

Nuclear medicine biliary studies have been routinely used to identify bile leaks that occur after laparoscopic cholecystecomy. The use of a Tc-99m mercaptoacetyltriglycine (MAG3) renal scan to diagnose a case of urinary leakage that occurred after a laparoscopic-assisted colectomy is shown in this report. Laparoscopic surgery is widely used in place of conventional laparotomy to minimize recovery time and discomfort after surgery. The complication rate for laparoscopic colectomy has been reported as approximately 6% to 10%. In particular, ureteral leak has been reported in 2% of procedures. Ascites of unknown origin can become a diagnostic dilemma. We present a case of postoperative ascites of unknown origin that was successfully diagnosed as urinary leakage using renal scintigraphy.