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A jelly belly: An unusual cause of ascites

      A 77-year-old man presented with a two-month history of increasing abdominal girth, weight loss and early satiety. Physical examination revealed a distended, nontender abdomen with dullness on percussion. The complete blood count and the liver function tests were normal whereas serologic tests for viral hepatitis were negative. A computed tomography (CT) scan of the abdomen showed a large amount of ascitic fluid resulting in central displacement of the small bowel and mesentery without septa of calcifications. A blind paracentesis in the left lower quadrant of the abdomen revealed a green gelatinous jelly which was impossible to aspirate. The ultrasonography (US) of the abdomen (Fig. 1) showed multiple septations in the peritoneal cavity surrounded by ascites with a “starburst” appearance and with echogenic foci within. The omentum appeared irregularly thickened. The bowel loops were displaced centrally and were non mobile instead of floating freely.
      Fig. 1
      Fig. 1Ultrasonography of the abdomen of a 77-year-old man with pseudomyxoma peritonei Panel A: ascitic fluid with multiple septations (arrows) and irregularly thickened omentum (asterisk) Panel B: “starburst” appearance of the ascitic fluid due to echogenic foci reflecting the gelatinous nature of the fluid.
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