Development of intractable ascites following upper abdominal surgery in patients with cirrhosis

Recently, two patients with cirrhosis in whom ascites intractable to medical therapy had developed were referred to Medical Center Hospital and Audie L. Murphy Memorial Veterans Administration Hospital. Ascites had developed in both following upper abdominal surgery. To better characterize postoperative ascites, the records of all patients with cirrhosis who had upper abdominal operations at these hospitals during a five-year period were reviewed. Patients with portacaval shunts or pre-existing ascites were excluded. Of the 31 patients meeting the study requirements, ascites developed in 12 in the immediate postoperative period. In 10, the ascites resolved with medical management. As a group, these 10 patients had more severe liver disease than the group in whom ascites did not develop. The remaining two patients had ascites intractable to medical therapy. The ascitic fluid protein level was high in these two patients as well as in the two referred patients with a mean value of 4.5 +/- 1.6 g/dl. One patient with intractable ascites died and the other three required operative management. No clinical or laboratory features distinguished the patients in whom intractable ascites developed from the patients in whom postoperative ascites did not develop. It is suggested that intraoperative injury to vessels draining hepatic lymph was the cause of the intractable ascites.