Ascites immediately following laparoscopic cholecystectomy is an extremely rare complication. Occasionally, no definitive aetiology can be ascertained despite a meticulous work-up. In such cases, idiopathic, allergic or an abnormal inflammatory peritoneal reaction may be the ultimate diagnosis. We present a case of ascites following a laparoscopic cholecystectomy presumed to be caused by a reaction to diathermy, and discuss its management. Introduction Ascites following laparoscopic cholecystectomy is an extremely uncommon event. Its exact mechanism is unknown, though an allergic or inflammatory peritoneal reaction has been described.1 It is imperative that serious, or life threatening conditions, for example bile duct or other visceral injuries are excluded. Under such circumstances, following a meticulous intra-abdominal search, an idiopathic allergic or inflammatory peritoneal reaction may be the final diagnosis. We present an unusual case of ascites, presumed to be secondary to diathermy following a routine, elective laparoscopic cholecystectomy and discuss its management. To our knowledge, this is the first reported such case in the medical literature. Case report A 31-year-old lady, 7 months post partum, who had a strong allergic history to a variety of allergens, including pollen, dust, fur, scent, feathers and animals, requiring daily oral and nasal antihistamines, underwent a laparoscopic cholecystectomy for cholelithiasis. The operation was performed in a routine manner; establishing a carbon dioxide pneumoperitoneum using Hasson's technique with a 10mm subumbilical port for telescope, a 10mm epigastric port, and two 5mm ports placed in the right lower and right upper quadrants for ancillary instruments. The operation was uneventful with no bile spillage or stone extrusion. The following day, the patient developed abdominal pain refractory to analgesics with an associated mild abdominal distension. Physical examination revealed tenderness in all four abdominal quadrants with shifting dullness on percussion. Bowel sounds were present and normal sounding. Full blood count, including an eosinophil count, and biochemistry tests were normal. An abdominal ultrasound scan revealed a large quantity of fluid within the abdominal cavity, which raised the possibility of either an intra-abdominal haemorrhage or a bile leak (fig1).
展开▼
