Gastric adenocarcinoma presenting as bloody ascites

Main Article Content

Felix Zhou
Ari Morgenthau
Thomas Arnason
Allen Tran

Keywords

bloody, hemorrhagic, ascites, gastric, malignancy, cancer

Abstract

A 71-year-old male presented to hospital with 3 months of increasing abdominal distention and pain. CT showed large volume ascites and gastric wall thickening in the antrum. He had no history of significant alcohol use or other risk factors for cirrhosis. He underwent paracentesis, and 3 litres of homogenously bloody ascites fluid was removed. Ascites cytology showed discohesive malignant cells. Upper endoscopy showed a 10 cm circumferential gastric mass. Biopsies revealed a diagnosis of gastric adenocarcinoma. The presence of homogenously bloody ascites can be a startling finding to healthcare providers. The differential diagnosis for bloody ascites includes hepatocellular carcinoma or other malignancy, hemorrhagic pancreatitis, perforated ulcers/varices, blunt trauma, and iatrogenic (suggested by recent paracentesis, transjuglar intrahepatic portosystemic shunt, or other procedure). The presence of bloody ascites in an otherwise relatively asymptomatic individual should prompt a search for malignancy. This case highlights a rare presentation of gastric adenocarcinoma as bloody ascites.

Abstract 191 | PDF Downloads 54 XML Downloads 47 HTML Downloads 28

References

1. Tarn A, Lapworth R. Biochemical analysis of ascitic (peritoneal) fluid: what should we measure? Ann Clin Biochem 2010;47(5):397–407.
2. DeSitter L, Rector W. The significance of bloody ascites in patients with cirrhosis. Am J Gastroenterol 1984;79(2):136–8.

Most read articles by the same author(s)