Differential diagnosis of massive ascites of unknown origin: An experience in a tertiary care hospital in Bangladesh
Md Ferdous Khan, Mohammad Abdur Rahman, Somnath, Sanjida Rahman
Background: Ascites denotes pathological accumulation of fluid in the peritoneal cavity. The word “Ascites” comes from the Greek word “Askitos”, which means bladder or bag. Massive ascites of unknown origin is an uncommon condition, which represents a diagnostic challenge. Accumulation of fluid within the greater peritoneal cavity – ascites - is usually encountered in clinical practice. Ascites is a common clinical problem, which can originate from hepatic, malignant, cardiac, renal, and infectious diseases. Aim of The Study: The aim of this review study was to discuss the current recommended diagnostic approach towards the patient with ascites and summarizes future diagnostic targets. Material and Methods: This was a descriptive, cross-sectional, analytical, and retrospective type of study, undertaken in the department of medicine of a tertiary care hospital in Bangladesh, over a period of one year from January 2018 to December 2019. The peritoneal or ascites fluid received were processed and studied for the cell count, number, cellular features, presence, or absence of organisms if any, and malignancies. Results: 75(50.15%) cases out of a total of 150 samples were received over a 1-year period. There was a slight male preponderance with 64(51.56%) cases and females composed of 6(48.44%) cases. The mean age of presentation among all patients was 51.6 years. A total of 13(10.24%) cases were malignancies. Conclusion: Peritoneal or ascites fluid is one of the common body fluids to be studied in everyday practice. Meticulous cytologic evaluation is of paramount importance as numerous malignant and non-malignant pathologies can cause effusions. The medical diagnosis of ascites is broad and includes an outsized number of benign and malignant causes. A structured diagnostic approach will likely reveal the etiology within the large majority of cases and is predicated on the subsequent elements: history, physical examination, blood tests, abdominal ultrasound, and diagnostic paracentesis.