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ASCITES FOLLOWING LAPAROSCOPY : Unusual Case
Manjiri S Mehta*, N A Dastur**, N K Sherier***
*Lecturer; **Hon. Prof. and Unit Head; ***Hon. Clinical Assistant; N Wadia Maternity Hospital, Acharya Donde Marg, Parel, Mumbai.
Ascites is not observed after laparoscopy. We cam across one such patient and hence the case reportMrs. ASV, 37 years, married since 8 years was admitted and operated for diagnostic hysterolaparoscopy with laparoscopic cauterisation of endometriosis and myomectomy as a treatment for primary infertility. Following this surgery the course in the ward was uneventful and she was discharged on 3rd post-operative day.
On 10th day following the laparoscopy she presented back with abdominal distension and vomiting. Her haematological investigations at the time of admission showed normal renal and liver function tests with total count 14,000 and increase in polymorphs. Hyponatraemia was revealed on electrolyte examination.
Chest X-ray showed no gas under diaphragm.
USG revealed marked ascites and normal viscera. On examination, she was mildly uncomfortable afebrile with pulse rate of 108/m. Rest of the vitals were normal. Abdomen was distended, with generalised tenderness and very sluggish peristalsis. Vulval oedema and tenderness was also seen. Speculum PR, and PV examinations did not reveal any abnormal finding.
Abdominal paracentesis done showed clear, colourless, odourless fluid.
Patient was kept under observation with antibiotics, nothing given orally and vital parameters monitored.
During the course of conservative management patient deteriorated with increase in ascites, increase in total WBC count and disappearance of peristalsis.
In view of diagnosis of suspected perforative peritonitis, a decision of exploratory laparotomy was made.
At the time of surgery clear transudate like fluid measuring approximately 1.4 lit was drained. The viscera was normal. The uterus including the site of myomectomy and adnexae were normal. The complete length of bowel was traced which revealed only serosal petechiae on ileum and appendix. Rest of the bowel was normal with no perforation. An intraperitoneal drain was kept. The postoperative course in the ward was uneventful and patient was discharged on 6th postoperative day.
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