Progressive abdominal distension with early satiety of ovarian origin

Specialty: Gynecology and breast.

• Increase in abdominal volume due to suspicion of ovarian tumor
• rapid abdominal fullness of gynecological origin
• suspected ovarian neoplastic ascites

Why it occurs

• Epithelial carcinoma of the ovary or fallopian tube with peritoneal carcinomatosis (malignant cause that needs to be ruled out urgently)
• Giant serous or mucinous ovarian cystadenoma
• Ovarian fibroma with ascites and pleural effusion (Meigs syndrome, benign)
• Massive ascites secondary to cirrhosis or decompensated heart failure simulating an adnexal mass

Initial workup

Immediate high-resolution transvaginal abdominal and pelvic ultrasound to assess the presence of massive free or septated ascites and characterize the ovaries (look for solid masses, thick septations, intracystic papillary projections and high resistance Doppler flow). Urgent serum tumor markers: Ca-125, HE4, Ca 19-9 and CEA. Computed Tomography (CT) of the chest, abdomen and pelvis with contrast for locoregional staging and search for peritoneal implants or pleural effusion.

Standard management

• No initial curative symptomatic medical or pharmacological outpatient treatment is available. Diuretics such as Spironolactone 100 mg/day orally in combination with Furosemide 40 mg/day can be used cautiously under hospital supervision for the temporary control of refractory symptomatic ascites. The treatment of choice consists of optimal primary surgical cytoreduction followed by adjuvant chemotherapy based on platinum derivatives and taxanes (note: in the event of persistent atypical digestive symptoms in postmenopausal women, gynecological ultrasound should always be considered to rule out ovarian cancer).