Current Management of Refractory Ascites in Hepatoma: A Case Report

Refractory ascites is a complication of chronic liver disease and hepatic malignancy. It occurs in 5-10 % cases and indicates a poor prognosis with a survival rate below 50 % if no liver transplant is performed. Refractory ascites is difficult to treat and significantly reduce patient’s quality of life. A 54 years old male hospitalized with chief complaint of abdominal pain and enlarged abdomen since 2 months ago. The patient has been diagnosed with hepatoma since seven months ago and routinely consumed oral furosemide and spironolactone. Paracentesis has been performed on patients four times in the last four months. Ultrasonography shows enlargement of the liver. During hospitalization, paracentesis of ascites fluid were carried out two times with a total of 12, 000 liters fluid evacuated. Large volume paracentesis (LVP) is the most feasible option for rapid management of ascites, and providing symptomatic relief in patients with tense ascites in limited resources setting. Other options such as Transjugular Intrahepatic Portosystemic Shunt (TIPS), Peritoneovascular Shunt (PVS), and Liver transplant should be considered for patients needing frequent LVP, if available and not contraindicated.