Purpose: To show the interest of the serum-ascites concentration gradient in albumin (SAAG) in the etiological diagnosis of ascites in African black. Materiel and Methods: This was a monocentric observational and analytical study performed on patients over 15 years old and hospitalized in the Hepato-Gastroenterology department of Cocody from January 1st, 2010 to March 31st, 2017 for ascites. The cytology and chemistry of the ascites fluid and the protidogram were performed. The main outcome measure was the prediction of portal hypertension (PHT) or non-portal hypertension related causes of ascites from SAAG. Results: The hospital prevalence of ascites was 11%. There were 82 women (46.9%) and 93 men (53.1%) with a sex ratio (M/F) of 1.1. SAAG was low in 68.6% of cases and high in 31.4% of cases. The most common etiologies were post-viral cirrhosis (74%), HCC (16.60%) and peritoneal tuberculosis (13.7%) respectively. In the case of high SAAG, 91% of ascites related to PHT were observed, but also 77.5% of a low SAAG corresponded to ascites related to PHT (p = 0.024) with Se = 35% Sp = 84% and accuracy = 44%. All patients with peritoneal tuberculosis had a SAAG low of less than 1.1 g/dl significantly (p = 0.002). SAAG had a diagnostic performance of 89% in peritoneal tuberculosis at the cutoff value of −1.24 g/dl (AUROC = 0.91, Se = 96%, Sp = 86%) while in post viral hepatitis cirrhosis at a threshold of 0.58 g/dl the diagnostic performance was 60% (AUROC = 0.69, Se = 53%, Sp = 79%). Conclusion: The simple technical SAAG, allowing to distinguish the ascites linked to the PHT and the ascites not bound to the PHT, can be used like a method of diagnosis of the etiologies of the ascites especially in the peritoneal tuberculosis in the African countries low income.

The duodenal metastases of a malignant melanoma are rare. We report a case at a 86-year-old, hypertense patient, without tumoral history, who was hospitalized in our department for a change of the general state and an anaemia ferriprive without found home (foyer) of display. In the clinical examination, we had found anemia syndrome, nodules under cutaneous about 2 cm in diameter at the level of the thorax, of the belly, the members and of the lower lip partners in a painless left adenopathy axillary about 3 cm in diameter and an absence of méléna in the rectal touch. The gastroscopy had highlighted polypoïdes ulcéro-bourgeonnantes hurts with a blackish pigmentation by places at the level of the bulb and of the second duodenum. In the histology of biopsie fragments, we noted a fuso-cellular proliferation and epithelioid with deposits of melanin. The positivity of antibodies anti-protein S100 and anti HMB45 in the immunohistochemical study allowed confirming the diagnosis. The gastroduodenal hurts, persons suffering from a liver complaint and lungworts in the scanner testify of a terminal metastatic scattering. The death arose two months later, in a picture of circulatory collapse further to a high digestive bleeding of big abundance.