The differential diagnosis for high gradient ascities includes cirrhosis, alcoholic hepatitis, cardiac ascites, or massive liver metastasis. The most likely diagnoses are peritoneal malignancy and treatable non-malignant diseases such as tuberculosis, pancreatitis, nephrotic syndrome, biliary disease, and serositis of connective tissue disease. In this case, there was no serologic evidence of these non-malignant diseases, and the radiological studies were suggestive, but not pathognomonic, of peritoneal malignancy. Unfortunately, the diagnosis of peritoneal carcinomatosis brings with it a predicted survival of weeks, except for some forms of ovarian carcinoma. Fluid removal by large volume paracentesis and symptomatic treatments are palliative.
Therapies involving intraperitoneal chemotherapy are experimental only.