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Peritoneal Effusion (Ascites)

Peritoneal effusion, also known as peritoneal ascites, is an abnormal collection of fluid in the peritoneal cavity that contains the intestines, stomach, and liver. Common symptoms include trouble breathing, loss of appetite, fatigue, and nausea. This condition can accompany cancers of the abdominal lining such as peritoneal mesothelioma. Learn what signs to watch for and how our team can help you get an accurate diagnosis.

Fact-Checked and Updated by: Jenna Tozzi, RN

Last updated:

What Is Peritoneal Ascites?

Peritoneal ascites (effusion) is a condition that causes excess fluid to collect between the thin layers of the peritoneum (abdominal lining).

Peritoneal ascites can occur with:

  • Cancers and carcinomas of the peritoneum, including peritoneal mesothelioma
  • Cancers of the breast, liver, ovary, and uterus
  • Cirrhosis (liver scarring)
  • Disease of the pancreas
  • End-stage renal (kidney) disease
  • Heart failure
  • Tuberculosis

Although peritoneal ascites can have a wide range of causes, recurring ones may be a symptom of mesothelioma. In fact, some doctors will consider recurring peritoneal ascites when diagnosing malignant mesothelioma.

This is because 60-100% of newly diagnosed peritoneal mesothelioma patients have ascites, according to a report in the Annals of Translational Medicine.

Is Peritoneal Effusion Dangerous?

On its own, peritoneal effusion is uncomfortable but not dangerous. Severe peritoneal effusion can cause stretching of the abdominal skin, shortness of breath, vomiting, and other symptoms.

However, peritoneal effusion can point to underlying illnesses such as mesothelioma, abdominal cancer, or liver cirrhosis. If you suspect you have abdominal effusion and it could be mesothelioma, you should see a specialist as soon as possible.

We can help you find specialists in your area and expedite your first appointment. Sign up for our Free Doctor Match program to get started.

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Causes of Peritoneal Effusion

Several medical conditions can cause peritoneal effusion. These include cancer cell migration, fluid buildup caused by tumors, and cirrhosis.

Cancer Cell Migration

When cancerous or malignant cells migrate into lymphatic channels and lymph nodes, they can block the fluid flow, resulting in an abnormal amount of fluid accumulation.

Cirrhosis of the Liver

Cirrhosis is one of the most common causes of free fluid in the abdomen. Cirrhosis is an advanced stage of liver disease with symptoms that can include nausea, appetite loss, unexpected weight loss, and fatigue.

People who are obese, have used alcohol for many years, are diabetic, and who inject drugs using shared needles are more likely to develop cirrhosis.

Cirrhotic ascites (ascites caused by cirrhosis) occurs when blood pressure in the blood vessel carrying blood from the digestive system to the liver (the portal vein) becomes too high. A person’s kidney function worsens as the pressure rises and fluid accumulates in the abdomen.

Tumors

Aggressive mesothelioma and other types of cancer tumors can produce fluid that gathers in the abdominal cavity.

Symptoms of Peritoneal Ascites

Peritoneal effusion symptoms vary depending on the severity of the condition.

Common symptoms of peritoneal ascites include:

  • Abdominal and intestinal pain
  • Abdominal distension (bloating or swelling)
  • Appetite loss
  • Chest pain
  • Difficulty sleeping
  • Fatigue
  • Impaired movement
  • Lower limb swelling
  • Trouble breathing (dyspnea)
  • Weight gain

If you or a family member is experiencing symptoms of peritoneal ascites, we can help you get an accurate diagnosis. Call our Patient Advocates now at (866) 608-8933 to learn more.

Types of Peritoneal Ascites

There are 3 main types of peritoneal ascites:

  1. Chylous ascites (CA) is milky looking and rich in a type of fat known as triglycerides. It is marked by the buildup of a fluid called chyle that comes from the lymph vessels connected to the intestines or the chest area.
  2. Exudate or exudative ascites has over 25 grams per liter (g/L) of protein and is usually caused by infection, hemorrhage, neoplasia (abnormal growth of tissues or cells in the body), or inflammation.
  3. Transudate ascites has a low amount of protein (less than 25 g/L). It usually occurs because of increased fluid leakage due to higher pressure in the blood vessels. This condition is often caused by health issues like high blood pressure in the liver (portal hypertension) or heart problems.

Diagnosing Peritoneal Ascites

If you think you have peritoneal ascites, doctors and other medical professionals may use the following methods to diagnose your condition:

  • Imaging scans such as CT scans and ultrasonography can reveal the presence of intraperitoneal fluid and prompt doctors to perform a peritoneal fluid analysis.
  • Paracentesis is a procedure that uses a plastic tube or hollow needle to take fluid from the abdominal cavity. After the doctors have taken a sample, they can perform cytology testing to look for signs of peritoneal mesothelioma.

It’s important to note that although a paracentesis can be used in the process of diagnosing peritoneal mesothelioma, a tissue biopsy is the only way to confirm a mesothelioma diagnosis.

Treatment Options for Peritoneal Effusion

After diagnosing you with peritoneal effusion, your health care team may prescribe the following treatments.

Paracentesis

Paracentesis can be used to treat peritoneal effusion. During this procedure, a doctor will drain excess fluid from the abdominal cavity using a needle or catheter.

A peritoneal drain for ascites can alleviate nausea, breathing difficulties, vomiting, and abdominal pain.

However, peritoneal fluid could build up again if the underlying cause (such as mesothelioma) isn’t treated. If the fluid returns, you will have to undergo paracentesis again.

Catheter Placement

Catheters are tubes that are implanted into a patient’s body that allow fluid to leave the peritoneum. Doctors frequently suggest installing certain types of catheters such as shunts for severe, recurring (returning) peritoneal ascites.

Chemotherapy

Patients whose peritoneal effusion is caused by peritoneal mesothelioma or other cancers may be eligible for chemotherapy.

After receiving chemotherapy, peritoneal mesothelioma patients may notice a reduction of ascites. The chemotherapy drugs kill mesothelioma cells, shrinking the tumors that cause fluid buildup.

If the cancer begins to grow again, ascites can recur. Cancer care teams may prescribe a second or third line of chemotherapy to control recurring ascites. They may also suggest undergoing paracentesis or getting an intraperitoneal catheter.

Surgery With Heated Chemotherapy

Finally, doctors may recommend cytoreduction surgery with heated chemotherapy (HIPEC) if a patient has peritoneal mesothelioma and ascites.

Cytoreduction with HIPEC removes visible tumors and kills the remaining cancer cells with a liquid solution of chemotherapy drugs.

This procedure significantly reduces the production of peritoneal ascitic fluid and often helps peritoneal mesothelioma patients live longer.

Learn more about treatments for peritoneal mesothelioma in our Free Mesothelioma Guide, shipped to your door overnight.

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Find Help for Mesothelioma Peritoneal Effusion

If you’re experiencing signs of peritoneal effusion, you may have peritoneal mesothelioma. Fortunately, we can put you in touch with experienced specialists who can provide an accurate diagnosis and recommend the proper treatment.

We’ve spent more than 20 years helping mesothelioma patients and their families get life-changing medical care and financial assistance to help pay for it.

Call our Patient Advocates today at (866) 608-8933 to get connected with top doctors who treat mesothelioma effusion.

Peritoneal Effusion FAQs

What are the symptoms of fluid in the peritoneal cavity?

People with peritoneal effusion may experience abdominal swelling, stomach pain, difficulty breathing, appetite changes, and vomiting.

If you are experiencing any of these symptoms, you make an appointment with a doctor for a proper examination and diagnosis.

What causes peritoneal effusion?

Several conditions can cause peritoneal effusion (fluid buildup in the peritoneal cavity), including liver cirrhosis and cancers of the peritoneum (the lining of the abdomen), liver, breast, and uterus.

The best way to confirm the cause is to see a doctor who can perform imaging scans and other diagnostic tests.

How do you treat a peritoneal effusion?

Doctors can remove peritoneal fluid through paracentesis and catheters. Traditional chemotherapy and surgery with heated chemotherapy can also get rid of peritoneal fluid by removing the cancerous tissues that are causing fluid buildup.

How long can you live once ascites starts?

Research has revealed that the likelihood of survival at 1 and 5 years after the diagnosis of malignant (cancerous) ascites is 50% and 20%, respectively. Long-term survival of over 10 years is extremely rare.

Although these statistics seem bleak, some malignant ascites patients manage to live long and fulfilling lives, especially if they receive early diagnosis and treatment for their underlying condition(s).

Talk to a doctor today if you think you have peritoneal ascites. They can extract your ascitic fluid and perform a diagnosis to determine whether your peritoneal ascites is linked to mesothelioma or another condition.

Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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References
  1. Cancer Research UK. “What is ascites?” Retrieved February 15, 2024, from https://www.cancerresearchuk.org/about-cancer/coping/physically/fluid-abdomen-ascites/about
  2. Cleveland Clinic. “Ascites.” Retrieved February 15, 2024, from https://my.clevelandclinic.org/health/diseases/14792-ascites
  3. Cleveland Clinic. “Cirrhosis of the Liver.” Retrieved February 15, 2024, from https://my.clevelandclinic.org/health/diseases/15572-cirrhosis-of-the-liver
  4. Dababneh Y, Mousa OY. (2023, April 24). Chylous Ascites. StatPearls. Retrieved February 15, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK557406/
  5. Huelin, P., Fortea, J. I., Crespo, J., & Fábrega, E. (2017). Ascites: Treatment, Complications, and Prognosis. InTech. Retrieved February 15, 2024, from https://www.intechopen.com/chapters/56674
  6. Kim, J., Bhagwandin, S., & Labow, D. M. (2017). Malignant peritoneal mesothelioma: a review. Annals of translational medicine, 5(11), 236. Retrieved February 15, 2024, from https://pubmed.ncbi.nlm.nih.gov/28706904/
  7. ​​Kopcinovic, L. M., & Culej, J. (2014). “Pleural, peritoneal and pericardial effusions – a biochemical approach.” Biochemia Medica. Retrieved February 15, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936968/
  8. Mount Sinai. “Peritoneal Fluid Culture.” Retrieved February 15, 2024, from https://www.mountsinai.org/health-library/tests/peritoneal-fluid-culture
  9. National Cancer Institute. “Malignant peritoneal effusion.” Retrieved February 15, 2024, from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/malignant-peritoneal-effusion
  10. Rudralingam, V., Footitt, C., & Layton, B. (2017). Ascites matters. Ultrasound (Leeds, England), 25(2), 69–79. Retrieved February 15, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5438051/
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