Urinary Ascites: An Imitator of Portal Hypertension-Related Ascites.

• Type of Material: Article
• Authors: Tony Z Zhuang, Emory University; Simon B Akhnoukh, Department of Medicine, Emory University School of Medicine, Atlanta, USA.; Gabrielle D Morris, Emory University; David Krakow, Emory University
• Language: English
• Date: 2022-09
• Publisher: Cureus
• Publication Version: Final Published Version
• Copyright Statement: © 2022, Zhuang et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.29581
• Title of Journal or Parent Work: Cureus
• Volume: 14
• Issue: 9
• Start Page: e29581
• End Page: e29581
• Keywords: ascites; paracentesis; urinary bladder perforation; portal hypertension; creatinine; urinary ascites
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Urinary ascites is a rare and lesser-known etiology of ascites that may mimic portal hypertension (pHTN). We present an unusual case of urinary ascites in a patient with no apparent risk factors for bladder rupture. A 56-year-old woman with an uncomplicated, remote history of abdominal surgery presented with recurring episodes of ascites of unknown etiology. Of note, she has a history of functional, chronic urinary retention due to paruresis, a phobia of public urination. She had abdominal distension on the exam. Paracentesis revealed an elevated serum-ascites albumin gradient (SAAG), concerning portal hypertension. Additionally, the ascites creatinine to serum creatinine ratio was found to be extremely elevated at over 1, and a CT cystogram ultimately revealed bladder rupture, indicating a source of urinary leakage into the peritoneal space. This case report discusses the clinical recognition of urinary ascites as a mimic of apparent portal hypertension-related ascites and appropriate management.