An excess of fluid in the peritoneal cavity was noted in 26 per cent, of our cases. The amount varied from six ounces to several quarts, the average being about two and a half pints. As a rule the fluid was clear, and of a pale yellow or straw colour, but occasionally it was slightly turbid or presented the appearance of thin pus. In two cases (0.75 per cent.) chylous ascites was observed. When associated with jaundice the effusion was always bile-stained, but in two cases this feature was observed although the skin and the conjunctivae retained their natural colour. This phenomenon seems to have been due to the obstruction of the thoracic duct, which was present in both instances, and which probably prevented the entrance of the bile pigment into the general circulation. Blood or blood-stained exudation existed in rather less than one quarter (23 per cent.) of the cases of ascites, and was usually attributable to the presence of soft hsernorrhagic growths upon the peritoneum, but in two instances there was coexistent thrombosis of the portal vein.
The causation of ascites in gastric cancer is a matter of some importance. We find that in 50 per cent, of our cases m which it occurred the peritoneum was the seat of an extensive carcinosis, but the liver was free from disease ; in 21 per cent, metastases were present in the liver, but the peritoneum was healthy; while in the remaining 29 per cent, both structures were affected with secondary growths. It is therefore obvious that the extension of cancer to the peritoneum is by far the most important factor in its production.
The analysis recorded in Table 8 indicates that ascites only occurs in about 13 per cent, of the cases where the pylorus is contracted, while 50 per cent, of the growths of the cardia and 75 per cent, of those which infiltrate the entire viscus are accompanied by peritoneal effusion. A comparison of these figures with those contained in Table 7 is sufficient to explain this curious fact, for it will be observed that neoplasms of the central or cardiac region of the stomach are not only more malignant than those which stenose the pylorus, but are especially prone to invade the peritoneum.
Situation of the gastric disease
Secondary growths in cases of ascites
Pylorus (with stenosis)
Pylorus (without stenosis) .
Walls and curvatures ....
General infiltration ....
13.2% 20.6% 34%
72% 12.5% 33.3% 33.3 %