RT Journal Article
SR Electronic
T1 Challenging and uncommon diagnosis of long-evolution ascites
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr-2017-222565
DO 10.1136/bcr-2017-222565
VO 2017
A1 Marta Gravito-Soares
A1 Elisa Gravito-Soares
A1 João Almeida
A1 João Fraga
A1 Luis Tomé
YR 2017
UL http://casereports.bmj.com/content/2017/bcr-2017-222565.abstract
AB 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.