Total Adrenalectomy in the Treatment of Intractable Ascites

Among patients in whom cirrhosis of the liver is accompanied by ascites there is a small group in whom the ascites cannot be abolished by the usual methods. Two patients of this type had failed to improve despite bed rest, diets low in sodium and moderately high in protein, intravenous administration of serum albumin, and paracentesis. In each case bilateral adrenalectomy was performed in two stages. In one case, that of a 50-year-old man, the interval between stages was 14 days; in the other, that of a 36-year-old woman, the interval was 12 days. The woman died two years later of delirium tremens but without recurrence of the ascites. The man made an excellent recovery. When ascites has proved intractable by the above criteria, the authors recommend bilateral adrenalectomy provided that the liver can reasonably be expected to regain some degree of functional competence.