CASE 278: UNKNOWN ASCITES, Dr PHAN THANH HẢI-Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 30 YO   ABDOMINAL PAIN  SOME MONTHS AGO,   ABDOMEN WAS DISTENTION AND  CANNOT EATING, NO FEVER  NO TRAUMA OR TUBERCULOSIS IN  HISTORY.
ABDOMEN ULTRASOUND  DETECTED ASCITES  WITH  BOWEL  ADHERENCE IN MASS, LIKE COCOON  SIGN ( 2 VIDEO).

MSCT of ABDOMEN WITH  CE REVEALED  NORMAL LIVER  WITHOUT TUMOR ( SEE  CT  3 PICTURES).

PUNCTURE of ASCITES SHOWED OLD  BLOODY  FLUID. ANALYSIS RESULTED NORMAL AMYLASE,  ADA, AND  CA 125.

PATIENT WAS ADMITTED HOSPITAL IN  EMERGENCY FOR  BOWEL  SUB-OBSTRUCTION.

LAPAROSCOPIC OPERATION   DETECTED  OLD BLOOD  WITH  ADHERENT FIBRIN  WHICH MADE BOWEL  AS A BALL (COCOON),  CANNOT FIND OUT THE BLEEDING SITE. NO TUMOR DETECTABLE, AND BIOPSY OF  ONE  OF PARIETAL PERITONEAL AREA THICKNESS.

MICROSCOPIC REPORT WAS  HEMORRHAGIC PERITONITIS.

WHAT IS THE  PLAN OF TREATMENT FOR THIS PATIENT ?.