A case of giant hydronephrosis containing 9,500 cc, simulating ascites due to 'cirrhotic liver in a twenty. three year old male, is presented. The differential diagnosis and the important clinical, laboratory and X-ray features are discussed with brief literatual review.
Ascites ; Diagnosis, Differential ; Humans ; Hydronephrosis ; Liver ; Male

Chyloperitoneum, also called chylous ascites, is a rarely reported complication of abdominal surgery. In most cases, the diagnosis and treatment is not difficult. The characteristic milky colored odorless fluid is easily detected by drainage or aspiration. With the help of diagnostic radiology and laboratory tests, it has become easier to detect the chyloperitoneum. Chyloperitoneum subsides spontaneously or responds well to medical treatment. Death from chyloperitoneum is extremely rare. However, 3 cases of medically intractable chyloperitoneum were encountered at our hospital after curative surgery for gastrointestinal malignancies (two colorectal cancers and one gastric cancer). Herein, the authors report these case and discuss their treatments.
Chylous Ascites* ; Colorectal Neoplasms ; Diagnosis ; Drainage

PURPOSE: We evaluated the CT criteria useful for the diagnosis of the site of bowel perforation in patients with this or mesenteric injury caused by blunt abdominal trauma. MATERIALS AND METHODS: CT findings of 26patients with blunt abdominal trauma were retrospectively analyzed by two observers who were unaware of operative findings, and the results of their analysis were compared with those findings. Twenty cases of bowel perforation found at the jejunum (8), ileum (9), and colon (3), and six cases of mesenteric injuries were confirmed byoperation. We evaluated CT findings of 1) segmental bowel wall thickening, b) focal mesenteric fat infiltration, c) loculated fluid collection and d) extraluminal air adjacent to the bowel, and in addition analyzed the locations of ascites and free air, and the associated injuries of solid organs. RESULTS: The most common finding at the site of bowel perforation was segmental bowel wall thickening (17 cases), followed by focal mesenteric fatinfiltration (12 cases), loculated fluid (12 cases) and extraluminal air ajacent to the bowel (9 cases). Segmental bowel wall thickening was present at 34 sites, and the perforations were confirmed at 17 of these(50%). Focalmesenteric fat infiltration was present at 19 sites ; the perforations were proven at 12(63%). Loculated fluid collections were confirmed at 12/20 sites(60%), and extraluminal air adjacent to the bowel at 9/12(75%). Thepositive predictive value of criteria a, b, d, c) was 100%, and the positive predictive values of a, b, c) and a,d) were 60 and 67%, respectively. We observed ascites in 16 cases and intraperitoneal free air in 8 cases, the locations of ascites and free air did not, however, significantly correlate with the perforation sites. CONCLUSION: Extraluminal air adjacent to the bowel was the most specific criterion, and segmental bowel wall thickening wasthe most sensitive criterion. of all criteria, the finding 'a, b, c, d' most accurately predicted the site ofbowel perforation.
Ascites ; Colon ; Diagnosis ; Ileum ; Jejunum ; Retrospective Studies

PURPOSE: To evaluate safe access route and success rate of percutaneous drainage of pelvic fluid collection. MATERIALS AND METHODS: The 35 percutaneous drainages of pelvic fluid collection under the CT and fiuorosocpic guidance were done in 32 patients. The anterior transabdominal approach was done in 20 patients, while the nine patients used the transgluteal approach through greater sciatic foramen. Three patients , who had septated or noncommunicating abscesses, underwent drainage using both approaches. The catheter was removed when the patient's symptom and laboratory data were improved or the amount of drainage and the size of fluid collection were markedly reduced. Success, partial success and failure were classified. RESULT: The causes of fluid collection were complication of intraabdominal operation in 27 patient. The diagnosis after drainage included abscess(21), Ioculated ascites(6), and hematoma(4). The 27 cases(30 procedure) were treated successfully and the mean duration of catheter insertion was 10 days. The partial successes were two cases(2 procedures), which had palliative purpose. Three cases(3 procedures) were failed, which were multiple Ioculated ascites of pancreatic origin(2) and recurrent abscess(I). The significant complication during the procedure or drainage was not noted. CONCLUSION: The percutaneous drainage .under CT and fluoroscopy was effective technique for the management of pelvic. fluid collection, using anterior transperitoneal and transgluteal route through greater sciatic foramen.
Abscess ; Ascites ; Catheters ; Diagnosis ; Drainage* ; Fluoroscopy ; Humans

Ascites ; diagnosis ; etiology ; Diagnosis, Differential ; Humans ; Liver Cirrhosis ; complications ; diagnosis

POEMS syndrome is a rare disease caused by monoclonal plasma cell proliferative disorder.The typical signs include peripheral neuropathy,organ enlargement,endocrine disease,M proteinemia,and skin changes.In clinical practice,the atypical,complex,and changeable clinical manifestations of this syndrome can easily lead to misdiagnosis and missed diagnosis.A case of POEMS syndrome with peripheral edema and ascites as the main manifestations is reported in this paper.
Humans ; Ascites/etiology* ; POEMS Syndrome/diagnosis* ; Edema/diagnosis* ; Skin

Although the peritoneum is rare site for a primary neoplasm, certain malignant neoplasms may arise from it. A case of 63-year-old woman who had a serous papillary carcinoma of peritoneal origin is reported. Extraovarian peritoneal serous papillary carcinoma was characterized by ascites, malignant washings, and omental involvement with bulky infiltration and/or multiple tumor nodules. The symptoms caused by diffuse spreading of the neoplasm over the peritoneum are the most important manifestation for clinical diagnosis of malignant primary neoplasm of peritoneum, especially serous papillary carcinoma. This behaving tumor was at least partially responded to therapy. In this report, we describe a case of serous papillary carcinoma of peritoneum carring on proper management with brief review.
Ascites ; Carcinoma, Papillary* ; Diagnosis ; Female ; Humans ; Middle Aged ; Peritoneum*

BACKGROUND: Detection of malignant effusion is important task in the routine laboratory work. However, in clinical laboratory where only Wright-Giemsa stained slides are examined it is not easy. So the author proposed a scoring system in the differential diagnosis of malignant effusion using the results of routinely tested items. METHODS: 61 samples of exudates (13 ascites, 48 pleural fluids) from 47 patients were included. The scores are summed based on the routine laboratory results. Items were as follows: protein concentration, dominancy of lymphocyte (lymphocyte count over 50%) and morphologic variety of lymphoid cells, mesothelial cell count, eosinophil count, and presence of tumor cells. Total summed full scores would be 8 points. RESULTS: The summed scores of 14 samples of malignant effusion were as follows: 7 points in 2 cases, 6 points in 1 case, 5 points in 8 cases, 4 points in 3 cases, with the mean score of 5.1 points. The 47 benign exudates showed 4 points in 1 case, 3 points in 4 cases, 2 points in 33 cases, 1 point in 9 cases, with the mean score of 1.9 points. If malignancy were postulated as summed score over 4 points, a statistically significant difference was observed between the summed score and effusion type (P<0.0001). CONCLUSIONS: Two groups of effusion can be distinguished: one group that showed more than 4 points, with malignant potential and the other group lower than 3 points with benign effusion. In case with high score, 4 points above, one should pay attention to the presence of malignant cells and even if tumor cells were not found, the possibility of malignant condition should be notified.
Ascites ; Cell Count ; Diagnosis, Differential ; Eosinophils ; Exudates and Transudates ; Humans ; Lymphocytes

The usual imaging findings of common splenic infarction are well known, while the findings for splenic infarctions in the accessory spleen or polysplenia are rare; these unusual imaging findings may make the diagnosis difficult. We report here on two patients who have complained of abdominal pain, and they were diagnosed as splenic infarction that developed in either the accessory spleen or as has having polysplenia. We can diagnose splenic infarction that unusually develops in the accessory spleen or polysplenia when we identify a round, hyperechoic, avascular solid mass on US, or when we identify a round, rim-enhancing, hypodense solid mass with adjacent inflammatory changes and a small amount of ascites on CT that is adjacent to the normal spleen or in one of splenules of polysplenia in the clinical settings of acute abdominal pain.
Abdominal Pain ; Ascites ; Child* ; Diagnosis ; Humans ; Infarction* ; Spleen* ; Splenic Infarction

We report a boy with acute pancreatitis without abdominal pain accompanied by hepatic hematoma and massive ascites due to unperceived trauma. The case was difficult to diagnose with image study and the level of amylase. Strong suspicion of pancreatic injury based on mechanism of injury and clinical evaluation would be required to avoid a delay in diagnosis.
Abdominal Pain* ; Amylases ; Ascites ; Diagnosis ; Hematoma ; Humans ; Male ; Pancreatitis*