• Nasir Hassan Luck, Anwaar A Khan, Altaf Alam, Arshad Kamal Butt, and Farzana Shafquat.
• Department of Gastroenterology, Sheikh Zayed Hospital Complex, F.P.G.M.I, Lahore.
• J Pak Med Assoc. 2007 Jan 1; 57 (1): 33-4.

AbstractThe objective is to determine causes of low serum ascites albumin gradient (SAAG) by direct visualization and obtaining biopsy samples using laparoscopic technique. This is a hospital-based, observational study conducted at Department of Gastroenterology, Sheikh Zayed Hospital, Lahore from January 2001 to April 2002. A total of 33 patients with ascites (SAAG < 1.1 g/dl)) were selected. The findings on history and clinical examination, information from laboratory and radiological investigations were recorded. Laparoscopic findings and histological reporting were correlated. The mean ages were 48.38 +/- 16.7 years. Fifteen (45%) patients were male. The mean duration of the presenting complaints was 3.33 +/- 1.9 months. Ascites was present in all with mean SAAG of 0.73 +/- 0.22. Laparoscopic evaluation showed tuberculous peritonitis in 22 (66.7%) patients and carcinomatous peritonitis in 5 (15.2%) patients. Biopsies were obtained from omentum in 20, peritoneal surface in 5 and liver in 12 patients. The histopathological diagnosis was granulomatous inflammation in 20 (60.6%) and diagnosis of malignancy was made in 7 (21.2%); one (3%) had Budd Chiari Syndrome, 4 (12%) had cirrhosis of liver with super-added Hepatocellular carcinoma and biopsy was non-conclusive in 1 patient. No complication of procedure occurred in this cohort. Laparoscopy is a safe diagnostic modality to establish the cause of low SAAG ascites.

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