Factors in the Control of Ascites.

Abstract

Ascites associated with portal cirrhosis of the liver is ordinarily controlled in one of 3 ways: by parcentesis, by variations of the Talma-Morison operation, or by the diuretics. All 3 procedures were employed in this case-study—a man of 58 with a long alcoholic history; a slight jaundice, malaise and some edema of the legs during the past 7 months; and an ascites of 2 months'duration. Paracentesis was made 5 times in all in the 8 weeks previous to operation, from 9 to 14 liters of fluid being removed each time. Analyses were made of the fluid. Omentopexy was accomplished 10 weeks after the onset of the ascites. A large fan of the omentum was brought out through a mid-line incision in the upper abdomen, spread out and sewn in place in a prepared properitoneal bed. The peritoneum was closed about the omental stalk with wide-apart mattress sutures. Convalescence was uneventful. The diagnosis of portal cirrhosis was confirmed at operation.

The reaccumulation of fluid in the peritoneal cavity subsequent to various attempts to establish additional collaterals is a frequent experience. It occurred even in Morison's first case. 1 Thus paracentesis postoperatively may often be necessary. Here, however, we substituted the action of specific diuretics, especially novasurol (merbaphen) as investigated by Keith and Whelan, 2 in an attempt to solve this post-operative problem. A particular study of the action of the diuretics was made during a 17 day period commencing 23 days after the omentopexy.

The usual amount of phenolsulphonephthalein (6 mgm.) injected intraperitoneally at the time of a preoperative paracentesis was slowly excreted by the kidney, appearing in the urine during the second hour; but 13% being excreted in 4 hours. This was in accord with the small quantity of urine excreted in spite of a normal water intake.