Turbid Orange Ascites in a Patient with Cirrhosis: A Case Report.

Abstract

Introduction: Unusual ascitic fluid colouration can provide important diagnostic clues but may also lead to unnecessary investigations if misinterpreted. Turbid orange ascites is rare and poorly described, with differential diagnoses, including chylous, haemorrhagic, malignant, and infectious causes.

Case presentation: We describe a case of a man in his late 60s with alcohol-related cirrhosis who was found to have striking turbid orange ascitic fluid on index abdominal paracentesis. Biochemical analysis demonstrated a high serum-ascites albumin gradient consistent with portal hypertension, elevated erythrocytes indicating haemorrhagic ascites, and moderate hypertriglyceridaemia, suggesting chylous ascites. The fluid colour resolved with supportive management and reduction in triglyceride levels.

Conclusion: This case highlights how combined haemorrhagic and lipid components may alter ascitic fluid appearance. Integrating visual assessment with biochemical findings and clinical context is essential to guide diagnosis and avoid unnecessary investigations.