title: Ascites as the initial presentation of gastrointestinal carcinoma.
abstract: BACKGROUND
  The rapid development of ascites in a patient without known liver disease is an uncommon occurrence in the Emergency Department. Initial stabilization may include therapeutic peritoneal lavage to reduce diaphragmatic pressure and halt the progression of respiratory compromise. In the absence of liver disease, the differential diagnosis should include a search for malignancy, which has been reported to account for up to 10% of all cases of newly diagnosed ascites.
  
  
  OBJECTIVE
  To discuss the differential diagnosis, evaluation, and treatment options associated with the development of acute malignant ascites.
  
  
  METHODS
  We report the case of an 86-year-old woman who presented with the chief complaint of an enlarging abdomen and worsening shortness of breath of 1 week's duration. Bedside ultrasound rapidly revealed a large amount of intraperitoneal free fluid as a cause for her abdominal distension and respiratory compromise. Laboratory analysis of her blood along with computed tomography scan of her abdomen and pelvis were unremarkable. Diagnostic and therapeutic peritoneal lavage was done and the patient's symptoms improved. Pathologic examination of the peritoneal fluid revealed metastatic gastrointestinal carcinoma.
  
  
  CONCLUSIONS
  Rapidly progressing ascites may be the sole presenting symptom of metastatic gastrointestinal carcinoma.
authors: University of Tokyo Medical School, Tokyo, Japan.
authors: Mai
authors: M
authors: Shimada
authors: Catherine
authors: C
authors: Berjohn
authors: David A
authors: DA
authors: Tanen
mesh_terms: D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology*; D018394:CA-125 Antigen / Q000097:blood; D002277:Carcinoma / Q000175:diagnosis*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D010533:Peritoneal Lavage; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000556:secondary; D013274:Stomach Neoplasms / Q000175:diagnosis*
chemical_list: D018394:CA-125 Antigen