He had been admitted a few weeks prior with bacterial peritonitis (infection of the fluid of his abdomen). He was treated with antibiotics and when he got better he went home. While home, his pain and swelling of his abdomen got worse so he came back to see us. Since I cared for him on the ward, I recognized him laying in the ER, so I went to find out what was going on. I grabbed the ultrasound to check out his swollen abdomen and found 2 layers of fluid, one thick on the bottom (likely pus) and a thinner layer with stuff floating inside it. It didn't look good and wasn't something I had really seen before on ultrasound so I grabbed Bill for a 2nd opinion. He too thought it was pus that we were seeing in the different fluid densities. We talked about our options since we were looking at a whole belly full of pus. The best option would likely be for Jim to do surgery, open him up, suck out all the fluid and wash him out, but Jim wasn't around. So we went with our own pus evacuation method of paracentesis and irrigation with saline when the catheter blocked. We took off about 4.5 L of horrible smelling brownish fluid followed by thick pus.
Thankfully the ER wasn't busy as it was a very time intensive process and it smelled so bad that I know I wouldn't have wanted to be another patient in there during that process. We readmitted him and restarted him on antibiotics. We aren't sure what the underlying etiology of his ascitic fluid is, but getting all that pus out has to be a good thing. His abdominal distension and swelling came down about 75% from when he came in, so he was feeling better.