Refractory ascites are buildups of fluid in the abdomen that do not respond to most reasonable attempts at medical treatment. An estimated 10% of cases of ascites are considered refractory or intractable, with the focus of patient care turning to keeping the patient comfortable rather than trying to resolve the problem. Most commonly, this condition is a complication of liver failure, although some other conditions can also cause similar fluid accumulations, especially in their end stages.
In patients with ascites, the abdomen becomes swollen and the fluid can be seen on medical imaging studies. Aspiration of the fluid with a needle can show a mixture of components, including a potential buildup of white blood cells if the patient develops an abdominal infection. Ascites are generally regarded as an ominous clinical sign, showing that a patient's body is struggling to process fluids and cannot clear them in an efficient manner. Refractory ascites are indicative of a serious shut down in the patient's body.
Some treatment options can include dietary changes, as well as the administration of diuretics to help the patient express fluid. If these more conservative measures do not work, a shunt may be implanted to drain the fluid from the abdomen into other areas of the patient's body so it can be eliminated. In patients with refractory ascites, the fluid buildup does not resolve with medical treatment or it recurs when the course of treatment is concluded.
Refractory ascites can be frustrating for patients and doctors alike. Fluid in the abdomen feels uncomfortable and may interfere with the function of various organs, putting the patient at risk of more complications. The patient can also have trouble fitting into clothing and may develop other symptoms associated with severe liver failure, such as jaundice. Managing the patient's liver health can help limit additional fluid deposition, as can using various treatment methods for ascites, including aspiration of the fluid, a procedure known as “tapping,” to relieve the pressure.
Patients with a history of liver problems are advised to monitor their health carefully and follow treatment recommendations to avoid the development of serious complications like ascites. If patients start to notice changes, a doctor can provide an evaluation to see if anything can be done, including adjusting the patient's treatment plan or providing new treatment options. The development of clinical signs like swelling in the abdomen is a sign for concern and should be addressed. The longer a patient delays treatment, the more resistant complications will be to treatment, although a diagnosis of refractory ascites will be delayed until all treatment options have been pursued.