Free perforation of the small bowel in Crohn's disease

(Byrom, 1933). The reasons for abdominal localization of the fluid are not clear. The fluid of myxoedema ascites is characteritically straw-coloured and has the properties of an exudate with a protein concentration of 40-60 g/l and an electrophoretic pattern similar to that of serum (Taipole and Hokkanen, 1956). This may be helpful in the differential diagnosis in patients with cirrhosis and congestive cardiac failure where the protein content of the ascitic fluid is low and the fluid has the characteristic of a transudate. Other workers (Paddock, 1950; Pathy, 1955) have shown a diuresis beginning at about 2 weeks after the initiation of L-thyroxine therapy. The initial response to L-thyroxine was disappointingly slow in the present case. Full thyroid replacement therapy had, however, not been attained in the patient at the stage when complete resolution of the ascites occurred. Myxoedema ascites is rare, and its onset may be insidious, but when it occurs it is usually massive and the diagnosis is often delayed. Myxoedema should always be considered in the differential diagnosis of ascites since it is one of the few diseases for which treatment is simple and curative and the need for repeated paracentesis is thereby avoided. Acknowledgments We wish to thank Dr K. Ball and Dr L. Blendis for allowing us to report details of a patient under their care.