HAROLD O. CONN
Unilateral edema may occur after portacaval anastomosis or other right-sided laparotomies in cirrhotic patients with ascites. This unusual pattern of fluid retention apparently develops as a consequence of operative communications between the peritoneal cavity and the subcutaneous tissue, especially with disruption of deeper layers of the wound. Ascitic fluid passes through these fistulas into the subcutaneous tissue and dissects to dependent portions of the body, including the scrotum and sometimes the ipsilateral lower extremity. Unilateral jaundice may develop as part of this phenomenon because of the presence of a relatively large amount of bilirubin bound to the albumin of the ascitic fluid, which had dissected subcutaneously. The edema distribution may be bilateral when incisions cross the midline and presumably may be left-sided after left-sided surgery. These phenomena may occur in noncirrhotic patients with postoperative ascites.
CONN HO. Unilateral Edema and Jaundice After Portacaval Anastomosis. Ann Intern Med. ;76:459–461. doi: 10.7326/0003-4819-76-3-459
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Published: Ann Intern Med. 1972;76(3):459-461.
Emergency Medicine, Hospital Medicine.
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