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Key Features

  • Two-thirds of cases are due to peritoneal carcinomatosis from adenocarcinomas of the

    • Ovary

    • Uterus

    • Pancreas

    • Stomach

    • Colon

    • Lung

    • Breast

  • One-third of cases are due to lymphatic obstruction or portal hypertension from

    • Hepatocellular carcinoma

    • Diffuse hepatic metastases

Clinical Findings

  • Nonspecific abdominal discomfort and weight loss

  • Increased abdominal girth

  • Nausea or vomiting caused by partial or complete intestinal obstruction

Diagnosis

  • Abdominal CT

    • Useful to demonstrate primary malignancy or hepatic metastases

    • Seldom confirms diagnosis of peritoneal carcinomatosis

  • Paracentesis demonstrates

    • Low serum ascites–albumin gradient (< 1.1 mg/dL)

    • Increased total protein (> 2.5 g/dL)

    • Elevated WBC (often both neutrophils and mononuclear cells but with a lymphocyte predominance)

  • Ascitic fluid cytology is positive in 95%

  • Laparoscopy is diagnostic in patients with negative cytology

Treatment

  • Diuretics not useful in controlling ascites

  • Periodic large-volume paracentesis for symptomatic relief; for patients approaching end of life, indwelling (PleurX™) peritoneal catheters can be left in place for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites

  • Intraperitoneal chemotherapy sometimes used

  • Prognosis is extremely poor: only 10% survival at 6 months

  • Ovarian cancer is an exception; with surgical debulking and intraperitoneal chemotherapy, long-term survival is possible

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