Massive ascites due to abdominal pregnancy

We describe a case of an abdominal pregnancy which presented in the first trimester with rapid accumulation of blood stained ascites. The ascites resolved completely following surgical removal of a gestational sac from the peritoneal cavity. The pathophysiology of ascites in this case may be similar to that in cases of ascites in other non-malignant gynaecological conditions.     

An unknown etiology of fetal ascites: acute intestinal intussusception

BACKGROUND: Intussusception is a frequent diagnosis during the first year of life. However, it is an uncommon and very rare pathology in neonates and premature infants. CASE REPORTS: Two full term neonates presented an antenatal intussusception associated with fetal ascites; another premature infant developed an intussusception at the age of 15 days. In the three cases the diagnosis of intussusception had only been established during the laparotomy. A recent review of the literature revealed 13 cases of antenatal intussusception, one of these being associated with fetal ascites. CONCLUSION: The differential diagnosis of fetal ascites should always include intussusception. Early recognition of this pathology and prompt surgical action would avoid fatalities.     

Stable electrotransformation of symbiont candidate diazotrophic bacterium with plasmids carrying selectable and screenable marker genes

Fluid and sodium retention with peripheral oedema and ascites are often seen in decompensated patients with diseases of the liver, kidney and heart and in malignancies. Despite a careful clinical examination including relevant biochemical tests, decompensation is associated with diagnostic challenges. Two cases are presented where a haemodynamic investigation of the splanchnic and systemic circulation contributed to the establishment of a correct diagnosis, and the advantages of this diagnostic tool are discussed.     

Modified vitreous surgery for subretinal neovascularization and hemorrhage

Chylous ascites is an extremely rare complication of abdominal aortic surgery. A case with a successful outcome is presented, followed by a review of the 17 published cases. Chylous ascites can result in nutritional imbalance, immunological deficit and respiratory dysfunction. Paracentesis confirms the diagnosis and provides symptomatic relief. Conservative management, beginning with a low-fat diet and medium-chain triglyceride (MCT) supplementation, is recommended, changing to total parenteral nutrition if unsuccessful. Failure of non-operative treatment may necessitate the need for laparotomy and ligation of leaking lymphatics or peritoneovenous shunting.     

Laryngeal atresia or stenosis presenting as second-trimester fetal ascites--diagnosis and pathology in three independent cases

Congenital atresia of the larynx is a rare abnormality. We describe three cases where prenatal diagnosis during the second trimester showed massive abdominal fetal ascites and at post-mortem, laryngeal atresia was identified in two cases, and severe laryngeal stenosis in the third. All were associated with pulmonary hyperplasia. No additional abnormalities were found in other systems. Overdistended lung tissue and ascites are resultant from aberrant laryngeal growth; laryngeal anomalies are a cause of isolated fetal ascites. The association of ascites and voluminous lungs should arouse suspicion of laryngeal atresia and should be an indication for careful pathological study of the fetal larynx.     

Ascites due to hypothyroidism

A 77-year-old man presented with ascites which was due to hypothyroidism. After the ascites had been brought into remission by salt restriction, diuretics and paracentesis, monotherapy with levothyroxine prevented recurrence. Ascites reappeared as soon as levothyroxine was withdrawn due to the patient's non-compliance. Distinctive aspects of this type of ascites are the high concentration of total protein in the ascites and the high serum-to-ascites albumin gradient (SAAG). The pathogenesis of ascites in hypothyroidism is unknown. Possible hypotheses include increased capillary permeability, obstruction to lymphatic flow caused by hyaluronic acid-albumin complexes, and diminished water diuresis due to excess antidiuretic hormone. A patient with unexplained ascites should be tested for hypothyroidism, especially when the SAAG is high (> 11 g/l).     

Peritoneal tuberculosis presenting as pyrexia of unknown origin in immigrants

Three immigrant patients with peritoneal tuberculosis seen over a three year period are discussed. All three patients presented with fever and minimal abdominal signs. One patient developed ascites while under investigation. In all cases, the fever was prolonged, liver enzymes were elevated and the ESR was raised. Two patients required laparotomy to make the diagnosis, and in the third tubercle bacilli were grown from the ascitic fluid. The difficulties in diagnosis are discussed.     

Refractory ascites due to portal vein thrombosis in liver cirrhosis--report of two cases

Portal vein thrombosis as a complication of liver cirrhosis has been reported to be extremely rare in Japan, as compared with European countries. There are few reports discussing the correlation of portal vein thrombosis with refractory ascites. Between January 1994 and December 1995, 20 cases (91%) of 22 patients with liver cirrhosis with ascites admitted to our hospital responded well within 2 months to a combination therapy of diuretics and albumin infusion, and the other two cases (9%) with refractory ascites were associated with portal vein thrombosis. The ascites in the first patient continued for 1 year, despite diuretics and albumin infusion therapy, and portal vein thrombosis was confirmed by autopsy. The ascites in the other patient continued for more than 4 months, and portal vein thrombosis was detected by ultrasound. Portal vein thrombosis was not found in the other 20 cirrhotic patients with ascites. These two cases suggest that portal vein thrombosis may be a contributing factor to refractory ascites in patients with decompensated liver cirrhosis.     

Ultrasonic diagnosis of fetal ascites (author's transl)

Fetal ascites is relatively rare, but confronts the obstetrician with difficult decisions. By X-ray methods such as plain X-ray or fetography fetal ascites may only be suspected. Performing ultrasonic examinations however it is not only possible to detect the fluid collection in the peritoneal cavity but as well to recognize the inducing causes. This is documented by sonograms of three cases observed within the last year. The different decisions for the obstetrician in respect to fetal ascites with or without malformations are discussed.     

Potential role of streptozotocin in enhancing ossification of the posterior longitudinal ligament of the cervical spine in the hereditary spinal hyperostotic mouse (twy/twy)

The differential diagnosis of ascites often leads to confusion and an inability to exclude its multitude of causes in many patients. In this review, we outline the clinical features and laboratory investigations that usually elucidate the cause of ascites for the clinician in a simple and logical manner. Roughly 80-85% of cases of ascites are related to underlying chronic liver disease, but cardiac failure, tuberculosis, malignancy-related ascites and other less common causes should always be considered. Careful evaluation of the patient, including a clinical history, physical examination and diagnostic paracentesis should routinely be performed to determine the cause of ascites. Fluid should be sent for cell count and albumin along with simultaneous determination of serum albumin to determine the serum: ascites albumin gradient. This gradient allows classification of the cause of ascites into portal hypertension-related and nonrelated with a diagnostic accuracy of > or = 97%. The causes of ascites are individually discussed in relationship to their clinical features and to the laboratory investigations that are relevant in each situation.     

A quantitative measurement of peritoneal drainage in malignant ascites

With a two-compartment model, a method is described for quantitative determination of peritoneal drainage rates in malignant ascites. Data on twenty-four patients are presented and comparison is made with the qualitative assessment of the integrity of diaphragmatic and mediastinal lymphatics on the basis of lymphoscintigrams. It is concluded that flow rates less than 50 ml/hour are usually associated with abnormalities of the diaphragmatic and mediastinal lymphatics, indicating that tumor permeation of these structures is a significant contributing factor to persistent, intractable ascites in patients with malignant diseases.     

Abdominal pain and ascites as manifestations of hereditary angioneurotic edema

Hereditary angioneurotic edema (HAE) is an infrequent autosomal dominant disorder characterized by a decrease in the levels or a dysfunction of the complement C1 inhibitor factor (C1 inh). The clinical presentation varies widely and involves any area of the organism. Gastrointestinal involvement is usually as abdominal pain and may be accompanied by ascites. De novo diagnosis of HAE with abdominal pain and ascites as a form of presentation is difficult with differential diagnosis with abdominal pain of unknown origin. The appearance of ascites is rare with few cases reported in the literature. Both abdominal pain and ascites disappear a few days after initiation of medical treatment. Occasionally exploratory laparotomy has been required. A new case of abdominal pain and ascites as manifestations of HAE is herein reported.     

Screening for mutations by enzyme mismatch cleavage with T4 endonuclease VII

BACKGROUND: The analytical pattern of ascitic fluid in peritoneal tuberculosis is frequently similar to that found in other causes of ascites. The diagnostic value of the ascitic fluid pH and lactate in cases of tuberculous peritonitis has not yet been established. METHODS: Ascitic fluid pH, lactate, total proteins, cell count, lactate dehydrogenase, glucose, and their blood-ascitic gradients were determined in 10 patients with tuberculous peritonitis (group I). These results were compared with those obtained from 40 patients with cirrhotic sterile ascites (group II), 16 patients with spontaneous bacterial peritonitis (group III), and 18 patients with malignant ascites (group IV). RESULTS: A decreased pH and an elevated lactate level in ascitic fluid were found in patients in group I in comparison with those in group II (p < 0.001). No significant differences were found between group I and groups III and IV. The arterial blood-ascitic fluid pH gradient was more than 0.10 (p < 0.001), and the ascitic fluid-serum lactate gradient was greater than 15 mg/dl (p < 0.001) in group I when compared with group II. No significant differences were found between group I and groups III and IV. CONCLUSIONS: Ascitic fluid pH and lactate are useful markers in differentiating tuberculous peritonitis from cirrhotic sterile ascites. However, these variables lack specificity, as they are also decreased and increased, respectively, in cases of malignant ascites and spontaneous bacterial peritonitis.     

Pseudo-Meigs'' syndrome caused by paraovarian fibroma

Meigs' syndrome includes an ovarian tumor, usually fibroma, associated with hydrothorax and ascites. It is accepted that uterine tumors, like fibromas, can also be associated with ascites and hydrothorax, but this is extremely rare. The mechanism of formation of peritoneal and pleural effusion is not well documented. The most likely pathogenesis ascribes the fluid formation to the filtration of interstitial fluid in the peritoneal through the tumor capsule, and the diffusion to the pleural space through the diaphragm lymphatic vessels at the foramen of Bochdalek. Paraovarian fibromas are also extremely rare neoplasms, probably of paramesonephric origin. It has been hypothesised that they can develop by proliferation of connective tissue cells around the Wolfian remnants. In this article, probably for the first time, a case of paraovarian fibroma with ascites and hydrothorax is presented.     

Cytologic study of ascites and the endometrium in ovarian carcinoma. Clinical significance

OBJECTIVE: To ascertain the usefulness of endometrial cytology with ovarian cancers when examining extension of the disease and to analyze significant factors associated with migration of ovarian cancer cells into the uterine cavity. STUDY DESIGN: Cytologic results on ascites and the endometrium were analyzed in 87 patients with primary ovarian cancer in the absence of metastasis to the endometrium or cervicovagina. RESULTS: Positive results for cytology were found in 62/87 of ascites cases (71.3%) and in 20/87 endometrium cases (23.0%). The 15 cases (15/62 or 24.2%) positive for ascitic and endometrial cytology, divided clinically into stage III (6 cases) and stage IV (9 cases), were classified histologically as serous, 7 cases; mucinous, 2 cases; clear cell, 4 cases; endometrioid, 1 case; and unclassified, 1 case. Half the clear cell carcinomas (4/8 or 50.0%) were positive in the ascites and endometrium. The ascitic volume at surgery exceeded 500 mL in 9/15 cases (60.0%). CONCLUSION: Papillae with basement membrane material in the cores may be structurally associated with migration of ovarian cancer cells into the uterine cavity, especially in clear cell carcinomas. Cytologic positivity of the endometrium and ascites significantly correlated with ascitic volume.     

Myxedema ascites

A 74-year-old man presented with mental obtundation and massive ascites without evidence of significant impairment of liver function. Thyroid function studies suggested hypothyroidism. Aspirated ascitic fluid had the characteristics of an exudate. Thyroid replacement therapy resulted in rapid clinical improvement with resolution of the ascites. Prompt recognition of myxedema ascites may prevent the inappropriate use of diuretic agents, therapeutic paracentesis, and sometimes unnecessary laparotomy.     

Non-African Burkitt's lymphoma in a young woman

Non-African Burkitt's lymphoma is presented in a 29-year-old, unmarried woman, who developed tumors in both breats and ovaries, ascites and pleural effusion. Assessment of B cells in the tumor cells, derived from ascites, pleural effusion and tumor tissue is 90%, surface IgM being consisted of 86%, in an average. Histologically, the tumor tissue demonstrates prominent, socalled starry-sky effect, and cytologically, tumor cells are poorly-differentiated lymphocytoid cells in their feautures.     

Role of surgical therapy in the treatment of refractory ascites

In 5-10% of cases ascites is not controlled by medical therapy and is defined refractory. These patients may be submitted to one of the four following surgical options: portal-systemic shunt, peritoneo-venous shunt, transjugular intrahepatic portal-systemic shunt, orthotopic liver transplantation. Although the portal-systemic shunt is efficient in clearing ascites, it does not improve the survival, which depends on liver function, and it is complicated by an important incidence of encephalopathy. Since the patients with refractory ascites and good hepatic risk are not usually many, it is possible to understand why derivative surgery has been disappointing with this indication. Although the peritoneo-venous shunt is associated with a significant rate of valve obstruction, it is an easy, effective and not expensive treatment. So, till now, it has been considered the first choice procedure of refractory ascites, if any situations, determinating the onset of postoperative complications, are not present. Recently a new method has been introduced in the therapy of portal hypertension, the transjugular intrahepatic portal-systemic shunt. This is a bloodless portal-systemic derivation and so it has caused great enthusiasm even if the available data are insufficient to give a definitive opinion on its role in management of ascites. Certainly the liver transplantation, which presents the great advantage to treat both the cirrhosis and its complications, seems to be the most rational therapy for these patients. However, at least for this moment, the well-known absence of organ donors makes still actual the palliative surgical measures.     

Pleural fluid accumulation due to intra-abdominal endometriosis: a case report and review of the literature

A case is presented of massive ascites and right sided pleural effusion caused by endometriosis. The final diagnosis was not made for a considerable time. Massive ascites and a right sided pleural effusion caused by endometriosis is rare, with fewer than 10 reports in the literature worldwide. Physicians should be aware of this potentially tentially treatable cause, having excluded other possibilities such as malignancy and tuberculosis.     

Alpha feto-protein and albumin in ascitic fluid in hepatocellular carcinoma patients

Alpha-feto-protein (AFP) is the most popular tumor marker for hepatocellular carcinoma (HCC). It is used in diagnosis and follow up of cases by estimating its rise in the serum. The aim of this work is to study the value of estimating AFP in ascitic fluid of HCC patients with ascites. This work is a case control study on 32 patients, including 22 cases with ascites and HCC and 10 control group with ascites due to liver cirrhosis without HCC. The level of AFP was estimated in serum and in ascitic fluid by Radio-immuno assay RIA. The serum ascites albumin gradient (SAAG) was assessed by measuring albumin in all samples using bromocresole green dye binding. Guided aspiration liver biopsy and ascitic fluid cytology was done, stained with H & E. It was found that, AFP level in serum was elevated in 72.7% of HCC patients, and in ascitic fluid was elevated 63.6% HCC patients. Also, there was a highly significant, direct positive correlation between elevation of AFP in serum and in ascitic fluid (r = 0.778). No elevation of AFP in serum and in ascitic fluid was detected in control group. Ascitic fluid cytology showed malignant cells in one case only. SAAG was significantly lower in the HCC group 0.83 gm/dl than the control group 2.43 gm/dl (p-value < 0.001). Elevation of AFP in ascitic fluid is of high importance in evaluation of HCC, and is as significant as serum and runs parallel to it. Estimation of AFP in ascitic fluid is much more significant in evaluation of HCC cases than ascitic fluid cytology.