Laparoscopy in the evaluation of women with unexplained ascites: an invaluable diagnostic tool
Tuesday, January 16th, 2007.
Polish Journal of Pathology. 2006;57(3):161-5. [Link]
Milingos S, Protopapas A, Papadimitriou C, Rodolakis A, Kallipolitis G, Skartados N, Markaki S, Dimopoulos MA, Antsaklis A.
1st Department of Obstetrics & Gynecology, University of Athens, Alexandra Hospital, Athens, Greece.
Abstract
Study Objective: To assess whether laparoscopy is a reliable technique for the investigation of women presenting with ascites and in whom the diagnosis remains obscure.
Design: Prospective nonrandomized clinical study (Canadian Task Force classification II-2).
Setting: University Departments of a tertiary referral center.
Patients: Women presenting in our institution with ascites in whom the diagnosis remained obscure after an extensive nonoperative diagnostic work-up.
Intervention: Undiagnosed cases were submitted to laparoscopy, and selective biopsy specimens were taken for histologic study.
Measurements and Main Results: Over a 3-year period, 73 patients were admitted to our institution with diffuse ascites. In 9 patients (12.3%), the diagnosis remained obscure, and these patients were further investigated with laparoscopy. Selective biopsy specimens obtained at laparoscopy clarified the specific cause of the ascites in all 9 patients. Peritoneal carcinomatosis was responsible in 5 patients (a metastatic gastrointestinal tumor in 1 patient, a malignant mesothelioma of the peritoneum in 1 patient, and a serous papillary carcinoma of the peritoneum and of the ovary in 2 and 1 patients, respectively). Three patients were found with miliary peritoneal tuberculosis, and the last patient had an unusual peritoneal reaction to methylene blue after laparoscopic adhesiolysis.
Conclusion: Laparoscopy is a valuable means of assessing the peritoneal cavity in patients with unexplained ascites, where the primary cause remains unclear. The diagnosis can be accurately made with selective biopsy specimens, and appropriate treatment can be instituted without delay.
Glossary
- diagnosis
- identifying a disease by its signs or symptoms, and by using imaging procedures and laboratory findings. The earlier a diagnosis of cancer is made, the better the chance for long-term survival.
- carcinoma
- (car-sin-o-ma) a malignant tumor that begins in the lining layer (epithelial cells) of organs. At least 80% of all cancers are carcinomas.
- biopsy
- (buy-op-see) the removal of a sample of tissue to see whether cancer cells are present. There are several kinds of biopsies. In some, a very thin needle is used to draw fluid and cells from a lump. In a core biopsy, a larger needle is used to remove more tissue.
- tumor
- an abnormal lump or mass of tissue. Tumors can be benign (not cancerous) or malignant (cancerous).
- mesothelioma
- a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.
- peritoneal
- (pair-uh-tuh-nee-al) the serous membrane that lines the cavity of the abdomen. (More on Peritoneal Mesothelioma.)
- ascites
- (uh-sigh-tees) excess fluid accumulation in the abdominal (peritoneal) cavity.
