The significance of bloody ascites in patients with cirrhosis.

Five percent of cirrhotic patients with ascites in our unit have grossly bloody fluid. Eleven of 32 randomly selected retrospective patients had hepatocellular carcinoma, one tuberculous peritonitis, seven prior trauma, and in 13 the bloody ascites was apparently spontaneous. Five prospectively encountered patients brought the number of cases of spontaneous bloody ascites available for review to 18. Three of these had sudden large intraperitoneal hemorrhages, and bloody ascites in the remaining 15 was incidentally noted at routine diagnostic paracentesis. Bleeding in the former three patients was from a retroperitoneal vein, spontaneous splenic rupture, and an unknown site, respectively. All patients required laparotomy and two died. Ascites red cells in the latter 15 patients may have been from a slowly leaking collateral vein or a hepatic lymphatic and required no treatment. However, the prognosis of these patients was significantly poorer than that of a control group of patients with similar liver tests and clear ascites.