• David A Tanen and Catherine Berjohn.
• University of Tokyo Medical School, Tokyo, Japan.
• J Emerg Med. 2013 Feb 1;44(2):e195-8.

BackgroundThe 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.ObjectivesTo discuss the differential diagnosis, evaluation, and treatment options associated with the development of acute malignant ascites.Case ReportWe 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.ConclusionRapidly progressing ascites may be the sole presenting symptom of metastatic gastrointestinal carcinoma.Copyright © 2013. Published by Elsevier Inc.

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