Para-normal-centesis: Percutaneous suction and traction removal of sclerosing peritonitis

Sclerosing peritonitis is uncommon and often arises as sequala of inflammation and may be asymptomatic or present with variable gastrointestinal symptoms. This case describes a 41-year-old female with decompensated alcoholic cirrhosis and refractory ascites who developed recurrent spontaneous bacterial peritonitis. Months later, she presented with failure to drain ascites on repeated paracentesis. Loculations and echogenic debris were visualized on abdominal ultrasound and percutaneous removal was performed revealing a 40 cm long pale white cord. Histopathologic analysis indicated features of sclerosing peritonitis without evidence of malignancy. This case demonstrates the unusual presentation, diagnosis, and treatment of sclerosing peritonitis, which only came to clinical attention when it impeded paracentesis in a patient with contraindications to other management options. Removal of this sclerotic tissue restored the ability to perform successful large-volume paracentesis for her refractory ascites.