BMJ Case Reports 2017; doi:10.1136/bcr-2017-222565
  • Rare disease

Challenging and uncommon diagnosis of long-evolution ascites

  1. Luis Tomé1,2
  1. 1Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  2. 2Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  3. 3Department of Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  4. 4Department of Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  1. Correspondence to Dr Marta Gravito-Soares, ms18498{at}
  • Accepted 20 November 2017
  • Published 2 December 2017


This is a case report of a 45-year-old Caucasian man with chronic alcoholism. No history of liver disease or asbestos exposure. He complained of ascites during the last 3 years with worsening in the last year with severe ascites development. Diagnostic paracentesis showed SAAG 1.1 and high cellularity with neutrophil count >250 cells/µL. Ascitic fluid cytology revealed reactive mesothelial hyperplasia. Thoracoabdominopelvic ultrasonography/CT/MRI and fludeoxyglucose positron emission tomography/CT showed ‘omental cake’ pattern suggesting peritoneal carcinomatosis. An exploratory laparoscopy revealed moderate interloop adhesions and necrosis with whitish exudate in the right pelvic excavation. Biochemical/cytological/histological/microbiological study only revealed reactive mesothelial cells, necrosis and lymphohistiocytic inflammatory infiltrate. A second exploratory laparoscopy with liver and peritoneal biopsies and appendectomy/mesoappendix excision showed a well-differentiated tubulopapillary mesothelioma. The patient was referred for intraperitoneal chemotherapy and is undergoing monthly therapeutic paracentesis.


  • MG-S and EG-S contributed equally.

  • Contributors MG-S and EG-S contributed equally to this work, namely the study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and administrative, technical or material support. MG-S is the article guarantor. JA contributed in all aspects of the study except drafting of the manuscript. JF contributed in all aspects of the study except drafting of the manuscript and study concept and design . LT contributed in all aspects of the study except acquisition of data, and he was solely responsible for study supervision. All authors read the final version of this manuscript, approve its content and submission for publication. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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