Topic Review - Newest First (only newest 5 are displayed)
chameed
Re: Clinical Challenge
Post-op massive ascites is rare but easy to drain through the cul-de-sac with a large bore needle like Touhy's.
yasir
Re: Clinical Challenge
Good case discussion. I think palliative care in this case would be more beneficial compared to treatment, because as you mentioned, the prognosis in this case is <25%. I want to know who would you treat massive recurrent ascites?
chameed
Re: Clinical Challenge
In one of the posts, docosama did mention 'Meigs" and based upon my level of experience, that was my clinical diagnosis from the beginning but I wanted that clinical diagnosis substantiated with one or two additional tests. I, then presented that situation to the patient and her family.
However, these are very difficult and risky procedures and as far I am concerned, patients must know in advance what they are in for.
We can discuss the pros and cons of laparoscopy but in the end, extensive laparotomy is required. Moreover, information to be gained from laparoscopy was available to me from MRI. Also an additional procedure increases the risks from anesthesia etc. I can tell you that drainage of ascitic fluid and creation of pneumo, sounds like a great idea but its not that easy to accomplish on the ground.
Work up was extensive and quick and all the possibilities had to be excluded one by one.
Her prognosis for five year survival is <25%. So far she has refused chemo, and I did not try to push that too much. My experience tells me that chemo has not done much good for the gyn cancer except in cases of chorio.
Her post-op course was uneventful except that she lost a few pounds but her apetite is normal and her GI and genito-urinary systems are working well. We shall see.
drkhawaja
Re: Clinical Challenge
Massive ascites is not a contraindication to laparocopy. In fact it makes laparosopy easy. All what has to be done is to remove fluid before creating a pneumoperitoneum. It is now well established that large volumes of fluid can be removed safely as practised during large volume or total paracentesis in patients with cirrhosis.
Thankyou for a good case discussion.
docosama
Re: Clinical Challenge
Great Work!
