An Unusual Case of Ascites in a Reproductive Female

Ascites, an accumulation of fluid in the peritoneal cavity, is commonly caused by liver cirrhosis and only 10% is attributed to malignancy.4 However, if other diagnoses are not considered, delay and mismanagement might ensue. Here we present a 28 year old female with sickle cell trait, obesity, PCOS, and a self-reported recent diagnosis of liver cirrhosis who presented to the ED with severe abdominal distention, vomiting, shortness of breath, and bilateral leg swelling. Ultrasound and CT scan of the abdomen showed moderate ascites and small dense liver while EGD showed no obvious signs of elevated portal pressure. Further investigation, including ascitic fluid analysis and in-depth history led to a pelvic ultrasound and endometrial biopsy which confirmed endometrial adenocarcinoma. Images for staging revealed diffuse peritoneal carcinomatosis (Stage 4B). The patient, who was uninsured, was discharged in stable condition with plans to initiate urgent chemotherapy pending Medicaid approval. A high degree of suspicion for alternative causes of ascites may be necessary, especially in cases such as this young, non- alcoholic female with laboratory and endoscopic results that do not support the ascites coming from decompensated liver cirrhosis. Moreover, with increasing incidence of endometrial carcinoma diagnosis, more thorough evaluation of abnormal uterine bleeding is appropriate, especially if high risk factors (metabolic syndrome, nulliparity) are present.