ABSTRACT
From its inception, the laparoscope has been an important tool in the assess ment o f causes o f fluid collection in the abdomen as well as in the diagnosis and subsequent management of peritoneal malignancies.1 Although most cases of as cites result from benign conditions worldwide, it is important to understand that benign and malignant conditions may occur concurrently and that a focused ap proach to the etiology of ascitic collection is mandatory for appropriate treat ment strategies. Among the non-malignant causes of ascites in cancer patients are cirrhosis, nephrosis, congestive heart failure and peritonitis secondary to pyogenic organisms and tuberculosis (Table 3.1). History, physical examination, and diag nostic paracentesis with cell counts, cytology, protein, lactate dehydrogenase de terminations, and culture will usually provide the diagnosis. Malignant ascites is seen most commonly in patients with ovarian, endometrial, breast, colon, gastric and pancreatic cancer (Fig. 3.1). The management of malignant ascites may in clude systemic chemotherapy, instillation of radioisotopes or chemotherapy drugs into the peritoneal fluid and peritoneal-venous shunting procedures.
