Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2015; 7(3): 39-42
Published online Mar 27, 2015. doi: 10.4240/wjgs.v7.i3.39
Respiratory distress due to malignant ascites palliated by hyperthermic intraperitoneal chemotherapy
Marijn Marinus Leonardus van den Houten, Thijs Ralf van Oudheusden, Michael Derek Philip Luyer, Simon Willem Nienhuijs, Ignace Hubertus Johannes Theodorus de Hingh
Marijn Marinus Leonardus van den Houten, Thijs Ralf van Oudheusden, Michael Derek Philip Luyer, Simon Willem Nienhuijs, Ignace Hubertus Johannes Theodorus de Hingh, Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
Author contributions: de Hingh IHJT performed the surgical operation; van den Houten MML and van Oudheusden TR wrote the manuscript; Luyer MDP, Nienhuijs SW and de Hingh IHJT critically reviewed the manuscript for intellectual content.
Ethics approval: The study was reviewed and approved by the Catharina Hospital Institutional Review Board.
Informed consent: Written informed consent was obtained from the patient for the publication of this case report and accompanying images.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ignace Hubertus Johannes Theodorus de Hingh, MD, PhD, Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. ignace.d.hingh@cze.nl
Telephone: +31-40-2396600 Fax: +31-40-2443370
Received: October 17, 2014
Peer-review started: October 18, 2014
First decision: November 27, 2014
Revised: December 28, 2014
Accepted: January 30, 2015
Article in press: February 2, 2015
Published online: March 27, 2015
Processing time: 165 Days and 11.8 Hours
Abstract

Malignant ascites is a common symptom in patients with peritoneal cancer. Current assumption is that an increased vascular permeability and obstruction of lymphatic channels lead to the accumulation of fluid in the abdominal cavity. This case report describes a severely symptomatic patient with malignant ascites. The previously healthy 73-year-old male was presented with abdominal distention causing respiratory distress. Computed tomography revealed large amounts of ascites, a recto-sigmoidal mass with locoregional lymphadenopathy and an omental cake. Biopsy taken during colonoscopy revealed an adenocarcinoma of the colon with signet cell differentiation. A widespread peritoneal carcinomatosis was found during a diagnostic laparoscopy. The extent of peritoneal disease rendered the patient not suitable for cytoreductive surgery with curative intent. The ascites proved to be refractory to ultrasound-guided paracentesis; thus, a decision was made to perform palliative hyperthermic intraperitoneal chemotherapy without cytoreductive surgery. Consequently, ascites production stopped, and the respiratory distress was relieved thereafter. The postoperative recovery was uneventful. Ascites recurred eight months later, and a second hyperthermic intraperitoneal chemotherapy procedure was performed. The patient was still alive at the time of writing, 16 mo after the initial diagnosis.

Keywords: Ascites, Intraperitoneal chemotherapy, Palliative hyperthermic intraperitoneal chemotherapy, Peritoneal carcinomatosis, Colorectal cancer

Core tip: Malignant ascites can cause debilitating symptoms in patients with peritoneal cancer. This report describes a patient with severe respiratory distress caused by malignant ascites from peritoneal colorectal carcinomatosis. The patient was successfully treated with hyperthermic intraperitoneal chemotherapy without cytoreductive surgery. Our results suggest that hyperthermic intraperitoneal chemotherapy without cytoreductive surgery should be considered in patients with symptomatic ascites, even when their prognosis is dismal.