Biliary Ascites.

Vol.:(0123456789) Biliary Ascites Received July 26, 2022 Accepted January 30, 2023 J Gen Intern Med DOI: 10.1007/s11606-023-08074-x This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023 To the Editor: The case report regarding “Biliary Ascites” and the link to intraperitoneal biliary leak prompted an interesting dis - cussion on the causes of dark ascitic fluid. 1 Although nor - mally associated with a biliary or pancreatic origin, other diagnoses must be considered. There are several additional etiologies for brown or black ascites to consider including metastatic melanoma, endometriosis, primary ovarian car - cinoma, and fungal peritonitis. Black ascitic fluid has been noted in cases of metastatic melanoma with gastrointestinal bowel perforation secondary to the initiation of cytotoxic chemotherapy.2 Interestingly, microscopy can identify mela- noma cells with abundant melanin granules in ascitic fluid.3 Significant information can be obtained from fluid analysis with the inclusion of amylase/lipase, cytology, and histology. In endometriosis, hemosiderin-laden macrophages may be the source of dark ascitic fluid.4 Besides pancreatic or biliary causes, it is important to identify alternative diagnoses for dark ascites fluid. Nicole L. Miller, MD1 Joezer Drapeau, DO1 Erika S. Abel, MD1 1Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA Corresponding Author: Nicole L. Miller, MD; Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA (e-mail: [email protected]). Declarations Conflict of Interest The authors declare that they do not have a conflict of interest. REFERENCES 1. Blank J, Anderson E, Mansoor AM. Biliary Ascites. J Gen Intern Med. 2022. https:// doi. org/ 10. 1007/ s11606- 022- 07727-7. 2. Oosting SF, Peters FT, Hospers GA, et al. A patient with metastatic melanoma presenting with gastrointestinal perforation after dacar - bazine infusion: a case report. J Med Case Rep 2010;4:10. 3. Kojima M, Namikawa K, Kase Y, et al. Black ascites. QJM Int J Med. 2021; 114(7):523–524. 4. Suikerbuijk KP, Halder FF, Jonges GN, et al. Dark ascites, an ovarian mass and a black dotted peritoneum. Neth J Med. 2019;77:03. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 1310 Published online February 10, 2023 83 (5):1310