Unusual ascites post laparoscopic cholecystectomy in old patient: Case report and review of the literature

• Published in: International journal of surgery case reports 2022-08, Vol.97, p.107426-107426, Article 107426
• Main Authors: Alfrryan, Othman, Othman, Sharifah A., Alabdulwahab, Norah, Amer, Nasser, Alghamdi, Hanan, Alshammary, Shadi
• Format: Article
• Language: English
• Subjects: Ascites; Case Report; Cholecystectomy; Laparoscopic
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.107426

Ascites that precede laparoscopic cholecystectomy is an infrequent event. Its actual mechanism is not identified, but an inflammatory or allergic peritoneal reaction has been proposed. It can a life-threatening or an acute serious condition; for instance, the bile duct or other visceral injuries are eliminated. We present a 83 years old, medically free, who presented with fever and right upper quadrant pain. Diagnosed with severe acute calculus cholecystitis. Diagnostic laparoscopy and laparoscopic cholecystectomy were done, with copious irrigation of the abdomen. Postoperatively, patient started to had tense with moderate tenderness abdomen. Drain output showed clear ascites fluid. Postoperative ascites culture returned back as negative. Ascites treated conservatively with fluid restriction and furosemide. As per our knowledge, this is the fourth case that was reported in the literature of medicine. This was a particular case related to ascites which emerged without any known cause. The medical history of a powerful allergic background is can be the reason for transudative ascites that take place following an uneventful, occasional laparoscopic cholecystectomy. There was a presumed abnormal peritoneal or allergic reaction to the diathermy. No specific aetiological aspect was known irrespective of an extensive search being carried out. In cases of idiopathic post-laparoscopic ascites, general care and support is needed and fluid restriction and possible diuretic might be needed with no need for surgical intervention. Further studies are recommended for understanding of the pathophysiology of the disease. •Causes of post laparoscopic ascites is still unclear, no enough studies about this subject yet.•Some believes it is an inflammatory responses or allergic reactions to materials applied during this procedure – or any other laparoscopic procedure- , such as electrocautery or CO2, like others' experience can be the final diagnosis in such conditions.•If there is no potential injury detected during a careful search, like in this condition, we believe that a person can conclude that an idiopathic peritoneal reaction potentially associated with aggressive fluid resuscitation in case of severe sepsis, bacterial dissemination with pneumo-insufflation and prolong operative time can cause irritation of the peritoneal surfaces. Plus, decrease venous return from increase intra-abdominal pressure. This will cause transmitting of the fluid from the peritoneal surfaces