Respiratory distress due to malignant ascites palliated byhyperthermic intraperitoneal chemotherapy

Malignant ascites is a common symptom in patientswith peritoneal cancer. Current assumption is that anincreased vascular permeability and obstruction oflymphatic channels lead to the accumulation of fluidin the abdominal cavity. This case report describes aseverely symptomatic patient with malignant ascites.The previously healthy 73-year-old male was presentedwith abdominal distention causing respiratory distress.Computed tomography revealed large amounts ofascites, a recto-sigmoidal mass with locoregionallymphadenopathy and an omental cake. Biopsy takenduring colonoscopy revealed an adenocarcinoma ofthe colon with signet cell differentiation. A widespreadperitoneal carcinomatosis was found during a diagnosticlaparoscopy. The extent of peritoneal diseaserendered the patient not suitable for cytoreductivesurgery with curative intent. The ascites proved to berefractory to ultrasound-guided paracentesis; thus, adecision was made to perform palliative hyperthermicintraperitoneal chemotherapy without cytoreductivesurgery. Consequently, ascites production stopped,and the respiratory distress was relieved thereafter.The postoperative recovery was uneventful. Ascitesrecurred eight months later, and a second hyperthermicintraperitoneal chemotherapy procedure was performed.The patient was still alive at the time of writing, 16 moafter the initial diagnosis.