Noel Cassar* and Nigel Heaton
Department of Transplantation and Hepatobiliary Surgery, BMI The Hampshire Clinic, UKFulltext PDF
Background: Intractable ascites is a debilitating complication of decompensated liver disease. Peritoneovenous shunts are an option when medical treatment or radiological shunts have failed or are contraindicated. The aim of this study was to see if in those patients with intractable ascites awaiting or considered unsuitable for liver transplantation, the insertion of a peritoneovenous shunt improved the clinical outcome of the patient. Materials and Methods: Patients who had insertion of a peritoneovenous shunt for intractable ascites between January 2012 and October 2017 were studied. Clinical and biochemical data was compared before and after shunt insertion and outcomes reviewed. Results: Fourteen patients who had a peritoneovenous shunt inserted were recruited into the study. The main indication was ascites arising from cirrhosis due to alcohol (43%). Of nine patients discharged from hospital, 8 (89%) decreased their ascites, with 4 of them (44%) not requiring further paracentesis. All 6 patients with renal impairment who were discharged improved their renal function after shunt insertion. Discussion and Conclusion: Insertion of a peritoneovenous shunt is an option for patients with refractory ascites not responding to medical treatment, when other therapies are contraindicated. In addition to palliation of symptoms, it also improves clinical outcomes and can serve as a bridge to liver transplantation.
Ascites; Drainage; Liver Failure; Peritoneovenous
Cassar N, Heaton N. Use of Peritoneovenous Shunts in Patients with Intractable Ascites in the Era of Liver Transplantation. Ann Clin Case Rep. 2020; 5: 1849..