Diagnostic challenges in gastric adenocarcinoma: a case report

Occam’s razor dictates that the simplest diagnosis is usually the correct one. In ascites of unknown origin, the top differentials must include cirrhosis, malignancy and cardiac failure. Investigations such as ascitic fluid cytology and computed tomography can help identify the underlying pathology, however, these investigations do not have perfect specificity and sensitivity. Thus, “normal” investigations cannot be used to completely dismiss important differentials. In a middle-aged patient with no evidence of cirrhosis or cardiac failure, Occam’s razor suggests that a surgeon thoroughly consider and definitively exclude an occult malignancy prior to removing it from the list of differentials.