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Peritoneal Lymphomatosis in a case of ascites with portal hypertension: a case report

Sachet Chandak1*, Deepak Amarapurkar

Peritoneal Lymphomatosis is rare and should be one of the differential diagnoses in patients with intractable ascites of unknown etiology. Its diagnosis is difficult and has to be differentiated from peritoneal carcinomatosis and tubercular peritonitis which are more common. We present a case of an elderly gentleman who presented with symptoms of abdominal distension, anorexia and weight loss. On examination he had pedal edema with gross ascites and splenomegaly without jaundice Ascitic fluid analysis revealed high SAAG, lymphocyte predominant and negative for malignant cells. Transjugular liver biopsy was normal with elevated HVPG suggestive of portal hypertension. Ascites with portal hypertension can be easily assumed to be due to cirrhosis of liver which is extremely common, if proper evaluation is not done. Subsequently diagnostic laparoscopy revealed ascites, omental thickening, peritoneum studded with deposits and biopsies confirmed Peritoneal Lypmhomatosis due to Follicular Lymphoma.Diagnostic laparoscopy is a useful tool in the accurate diagnosis of peritoneal diseases. With timely and correct diagnosis, Peritoneal Lymphomatosis can be treated with chemotherapy to improve the outcome.