Journal of Surgery - JuniperPublishers Abstract Malignant ascites is an ominous sign that indicates peritoneal metastasis of the primary malignancy. The average survival after development of malignant ascites is only about 5 months. Malignant ascites may be associated with a variety of neoplasms including, ovarian, breast, colo-rectal, gastric, hepatobiliary and pancreatic carcinomas. The ascites per se and need for repeated paracentesis adversely affect the quality of life and also increase the risk of morbidity. Management of malignant ascites is essentially palliative. Conventional first-line approach to a patient with tense ascites includes paracentesis, diuretics or combination of both. Peritoneovenous shunts have also been utilized in selected patients with such situation. However, these approaches have limited efficacy and associated with high morbidity rates. Although effective options for the management of malignant ascites are limited, newer modalities like targeted t