Answer 2


The problem:
The problem here is the rapid accumulation of tense ascites in a young woman post complicated-delivery and hysterectomy without a clear cause .

Discussion:
In a discussion with the same internal medicine residents who shared in case1, they divided into opinions postulating :
-the presence of a general cause which may be the liver disease the history stated but this was not supported because the liver disease is not associated with symptoms, signs or labs supporting this postulation.
-likewise another suggested cardiac failure as the cause but again this is not supported clinically.
-other postulation is the presence of an intestinal leak that occurred as a complication of hysterectomy operation but this was not supported by the absence of the constitutional symptoms and specific local signs occurring in such situations .

Don't Forget (URINE ASCITES):
There are some notices deserving some intuition:
-the occurrence of ascites after a surgery involving the pelvis
-occurrence of ascites directly after removal of the urinary catheter (mentioned in history)
-relieving of ascites dramatically after re-insertion of the urinary catheter
So, it is clear that the patient had what is called "urine ascites" as a result of bladder injury during hysterectomy with a possibly small tear that opened after increasing the bladder internal pressure after removal of the catheter and urine accumulation.

Follow-up:
Tense ascites was relieved by abdominal paracentesis and re-insertion of the urinary catheter with a sample, of a uriniferous odour, sent to the lab for a usual urine analysis.
The case now has a complete relief of symptoms and distention.