Ascites as the initial presentation of gastrointestinal carcinoma
Mai Shimada1, Catherine Berjohn, David A Tanen
1University of Tokyo Medical School, Tokyo, Japan.
Background:
The rapid development of ascites in a patient without known liver disease is an uncommon occurrence in the Emergency Department. Initial stabilization may include therapeutic peritoneal lavage to reduce diaphragmatic pressure and halt the progression of respiratory compromise. In the absence of liver disease, the differential diagnosis should include a search for malignancy, which has been reported to account for up to 10% of all cases of newly diagnosed ascites.
Objectives:
To discuss the differential diagnosis, evaluation, and treatment options associated with the development of acute malignant ascites.
Case Report:
We report the case of an 86-year-old woman who presented with the chief complaint of an enlarging abdomen and worsening shortness of breath of 1 week's duration. Bedside ultrasound rapidly revealed a large amount of intraperitoneal free fluid as a cause for her abdominal distension and respiratory compromise. Laboratory analysis of her blood along with computed tomography scan of her abdomen and pelvis were unremarkable. Diagnostic and therapeutic peritoneal lavage was done and the patient's symptoms improved. Pathologic examination of the peritoneal fluid revealed metastatic gastrointestinal carcinoma.
Conclusion:
Rapidly progressing ascites may be the sole presenting symptom of metastatic gastrointestinal carcinoma.
Related Concept Videos
Ascites
Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
Appendicitis
Cirrhosis I: Introduction
Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by transmural...
