Massive Ascites of Unknown Origin in a Young Woman: A Case Report on a Diagnostic Dilemma for the Family Physician

Ascites is most commonly associated with chronic liver disease, malignancy, cardiac failure, or nephrotic syndrome. Idiopathic ascites in young adults without predisposing risk factors is rare and diagnostically challenging. We report the case of a 29-year-old nulliparous woman who presented with progressive abdominal distension and weight loss. Extensive laboratory evaluation, imaging studies, ascitic fluid analysis, and tumour marker assessment failed to reveal a definitive cause. A transient right pleural effusion and mildly elevated CA-125 raised suspicion for Meigs’ syndrome; however, no ovarian mass was identified. After approximately five months of persistent ascites and multidisciplinary management, the condition resolved spontaneously without definitive therapy. This case highlights the complexity of evaluating ascites in low-risk young patients and underscores the importance of coordinated primary care, careful diagnostic stewardship, and longitudinal follow-up when investigations remain inconclusive