Lindia Prabhaswari, I Gede Sadu Pratama Werdi, Lisa Anggriani Susanto, I Wayan Sunaka
Abstract: Refractory ascites is a common complication of liver cirrhosis. It is associated with a significant reduction of survival to 50% at 6 months and related to various complications, even without any precipitating factors. This article reported a 48-year-old man, with history of liver cirrhosis, who presented with dyspnea and stomach enlargement. There was a tense ascites (grade 3) and distension found on abdominal examination. Patient consumed spironolactone and furosemide routinely. He had history of frequent ascites paracentesis, about four times in the last three months. During current hospitalization, paracentesis was again performed, and about 6,000 mL of yellowish fluid was evacuated. A number of modalities are available for the management of refractory ascites, including dietary sodium and fluid restriction, diuretic therapy, large volume paracentesis (LVP), insertion of a transjugular intrahepatic portosystemic shunt (TIPS), and consideration for liver transplantation. However, paracentesis is still the first-line treatment, as it can be easily performed safely.
Keywords: chronic liver disease, liver cirrhosis, paracentesis, refractory ascites