Fibrinous peritonitis: a complication of practolol therapy.

Mrs. A. B., aged 56, developed angina pectoris in 1970 and in 1972 was put on practolol 100 mg three times a day in addition to oxazepam 15 mg three times a day and digoxin 0-25 mg twice a day which she had been having since 1971. She developed a rash on her hands, which spread rapidly, and a dry lumpy sensation in her eyes, with reduced secretion of tears. In March 1974 she first noticed abdominal discomfort and one month later her general practitioner found a cystic swelling arising from the pelvis. At a gynaecology department, 14 days later, the swelling had vanished. During the summer she suffered from abdominal pain, distension, pyrexia, and sweating, and was admitted to hospital in August. She had a lower abdominal swelling. Routine laboratory and radiological investigations gave normal results. Mrs. A. B. went home after the practolol had been reduced to 100 mg twice a day. But after two attacks of pain, nausea, and vomiting she was readmitted to hospital for an emergency laparotomy. There were soft masses in the epigastrium and the pelvis. The abdomen was full of fibrinous adhesions, which in places formed cocoons around several loops of bowel. These cocoons were filled with clear serous fluid and were the masses felt on abdominal examination. The obstruction was due to kinking of the small intestine, which was dissected out by blunt and sharp dissection. Practololinduced fibrinous adhesions were diagnosed at operation and the treatment stopped. The rash faded and her postoperative course was satisfactory until the fourth day, when she complained of severe chest pain, collapsed and died. Necropsy showed a bluish purple lichenoid rash on the back of both thighs. There were fine tacky adhesions between visceral and parietal pericardium, visceral and parietal pleura, and in the peritoneum. Apart from severe coronary arteriosclerosis with a fresh thrombosis at a stenosis in the first part of the left coronary artery and oedema of the lungs, all the major organs of the body looked normal. The skin presented striking changes of the type described by Felix et al.4