Anaesthetic management of abdominal distension (a case report).

A 25-year-old female patient was admitted to hospital with complaints of amenorrhoea for 9 months, abdominal distension for 6 months and swelling of the legs for 3 months. She had slept poorly for the previous 2 months because of extreme breathlessness. The swelling had increased gradually, extending upwards from the lower abdomen. On examination, the patient appeared exhausted and grossly undernourished. The pulse was regular but rapid (140 beats/min). Respiration was laboured and shallow, and the respiratory rate was 36 b.p.m. The accessory muscles of respiration were active, and the subcostal angle was markedly widened. On auscultation of the chest, crepitations and rhonchi were audible at both lung bases and air entry was poor throughout. A soft systolic murmur, most marked in the pulmonary area, was detected. The arterial pressure was 100/40 mm Hg. The abdomen was so enormous that the patient appeared to be hidden behind the huge swelling (fig. 1). A fluid thrill and shifting dullness were elicited. A seconddegree uterine prolapse was present also. The haemoglobin concentration was 5.5 g/100 ml, serum electrolyte concentrations (Na+, K.+, Ch, HCOi) were within normal limits and there were no abnormal biochemical findings in the urine. A large ovarian cyst with second-degree uterine prolapse and severe anaemia were diagnosed. On the day of admission, 3600 ml of blood-tinged fluid was tapped with a view to relieving the respiratory embarrassment. The fluid showed a protein content of 5 g/100 ml and a cell count of 148/ml. 500 ml of whole blood was transfused and haematinics and a high protein diet were given. In view of a continuing respiratory embarrassment, which was attributed solely to abdominal distension, it