Differential Diagnosis And Clinical Analysis Of 53 Cases Of The Causes Of Ascites

ObjectiveCirrhosis,malignant tumor and tuberculous peritonitis are the common causes of ascites.In addition,other causes such as cardiogenic disease,connective tissue disease,hypothyroidism and some rare diseases such as eosinophilic gastroenteritis can also lead to ascites.In this study,the causes of ascites of 53 cases were summarized and analyzed in order to provide clinical thinking for the diagnosis and differential diagnosis of ascites diseases.MethodsIn a retrospective study selected 560 patients were diagnosed with “ascites of unknown origin”,from January 2005 to January 2020 in the First Affiliated Hospital of Dalian Medical University.Excluding cirrhosis,common malignant tumor and tuberculous peritonitis,a total of 53 patients with ascites of other etiologies were collected.According to different etiologies,53 patients were divided into two groups:non cancerous ascites group and cancerous ascites group.The causes of non cancerous ascites group(31 cases)included: Budd Chiari syndrome(13 cases),portal vein thrombosis(8 cases),hypothyroidism(3 cases),systemic lupus erythematosus(2cases),restrictive cardiomyopathy(1 case),eosinophilic gastroenteritis(1 case),rheumatoid arthritis(1 case),hepatic sinus obstruction syndrome(1 case),POEMS syndrome(1 case).The causes of cancerous ascites group(22 cases)included: primary peritoneal cancer(8 cases),peritoneal malignant mesothelioma(6 cases),primary duodenal cancer(5 cases),unknown etiology(2 cases),vater ampulla cancer(1case).The clinical data were collected,including etiology,gender,age,clinical manifestations,tumor markers,routine and biochemical examination of ascites,cytologic examination of ascites fluid,imaging examination,endoscopy,laparoscopic exploration and histopathology.Statistical analysis was performed using statistical software SPSS 23.0.The measurement data were expressed as mean ± standard deviation.The measurement data of normal distribution were compared by t test,and non-normal distribution were tested by rank sum.The count data were expressed in rate(%),and analyzed by chi-square test.P < 0.05 was considered statistically significant.Result1.The etiologies of ascites were complicated and varied after the removal of cirrhosis,common malignant tumor and tuberculous peritonitis.Among the causes of non cancerous ascites,Budd Chiari syndrome(41.9%)and portal vein thrombosis(25.8%)were common,and rare causes such as eosinophilic gastroenteritis(3.2%)and hepatic sinus obstruction syndrome(3.2%)were also included.Primary peritoneal cancer(36.4%),peritoneal malignant mesothelioma(27.3%)and primary duodenal cancer(22.7%)were common in the rare sites of malignant tumors.There were 2cases with unknown etiology and the ascites was milky white.2.The difference of LDH,CEA and CA199 in ascites between cancerous ascites group and non cancerous ascites group was significant(P<0.05).The ascetic LDH,CEA and CA199 were 5,89 and 2 times higher in cancerous ascites group than in non cancerous ascites group.In this study,16 cases of cancerous ascites were examined by cytologic examination of ascites fluid and tumor cells were found in ascites of 10 cases.3.The presence of ascites was indicated by various imaging examinations in 53 patients.One case of Budd Chiari syndrome,one case of portal vein thrombosis and one case of primary duodenal cancer were found by B-ultrasound.CT examination showed 12 cases of Budd Chiari syndrome,8 cases of portal vein thrombosis,1 case of hepatic sinus obstruction syndrome,8 cases of primary peritoneal cancer,6 cases ofperitoneal malignant mesothelioma and 2 cases of primary duodenal cancer.One case of restrictive cardiomyopathy and one case of primary duodenal cancer were found by MRI.One case of primary peritoneal cancer and one case of peritoneal malignant mesothelioma were found by PET / CT.4.In this study,5 cases of primary duodenal cancer were examined by gastroscopy,and 4 cases were diagnosed as duodenal cancer directly.Laparoscopic exploration was performed in 2 patients.One case was diagnosed as primary peritoneal cancer and the other as peritoneal malignant mesothelioma by histopathology.Conclusion1.Excluding cirrhosis,common malignant tumor,tuberculous peritonitis,other causes of ascites complex and diverse.In the non cancerous ascites,Budd Chiari syndrome and portal vein thrombosis were common.In addition,attention should also be paid to the rare causes such as eosinophilic gastroenteritis and hepatic sinus obstruction syndrome.Primary peritoneal cancer,peritoneal malignant mesothelioma and primary duodenal cancer were common in the rare sites of malignant tumors in cancerous ascites.Chylous ascites was rare in clinic and difficult to diagnose.2.Combined detection of ascites with multiple indexes,exfoliative cytology unite,endoscopy and imaging examination are helpful for the differential diagnosis of ascites.3.For the uncertain ascites which can not be determined by various laboratory tests and imaging examinations,laparoscopic exploration and biopsy should be performed as early as possible.