Tissue Plasminogen Activator (tPA) Use in Persistent Loculated Ascites

Spontaneous bacterial peritonitis (SBP) complicated by loculated ascites presents a therapeutic challenge, particularly when standard of care or surgical intervention is not feasible. This case report documents the successful use of intraperitoneal tissue plasminogen activator (tPA) as adjunctive salvage therapy in an adult female with decompensated liver cirrhosis and loculated infected ascites. After no improvement in the patient's clinical condition following 14 days of intravenous antibiotics, catheter-directed intraperitoneal tPA was administered for three days, resulting in the improvement of her abdominal pain and resolution of the loculations. This case provides additional support for the potential efficacy of tPA as salvage therapy in managing loculated infected ascites in cirrhotic patients who have failed standard treatments.