Acute presentation of ascites in association with colon cancer.

CASE HISTORY An 80 year old man presented with gross ascites and altered bowel habit. Investigations, including a barium enema and Duplex Doppler ultrasound, revealed a colonic carcinoma and a portal vein thrombosis (figure). The ascites was a transudate and did not contain any malignant cells. The ascites responded satisfactorily to treatment with spironolactone and he then underwent a left hemicolectomy. The ascites recurred a few days after his surgery, and this had to be aspirated. He made a good recovery and was discharged to continue treatment with spironolactone.