Peritoneo-venous shunt (P-V shunt) has been known to be an excellent method of treatment of refractory ascites. However, it is sometimes difficult to decide the timing of its commencement because of its serous complications such as volume overload and disseminated intravasealor coagulation (DIC). We present a series of patients who underwent P-V shunt operations resulting in various outcomes.
Method : We performed P-V shunt in a series of thirteen patients with refractory ascites admitted to our institute from 1993 to 2005 using Denver or Le Veen shunt system. The background of these patients included liver cirrhosis with or without hepatocellular carcinoma (6 cases), carcinomatous peritonitis from advanced pancreatic cancer, primary biliary cirrhosis (one case), poor nutrition after pancreatoduodenectomy (one case), and liver metastasis from advanced colon cancer (3 cases; one after hepatic resection). The efficacy and potency of the shunt and the outcomes after shunt operation were analyzed.
Result : Body weight and abdominal circumference were reduced after shunting in 12 patients, and 10 were discharged. Complications were observed in 4 cases. Three cases died within 7 days after operation due to liver failure and cachexia due to carcinoma. All 3 patients had suffered from unstable status of respiratory and circulating system before operation. The average survival period of all the patients was 559 days.
Conclusion : Although P-V shunt is excellent treatment for intractable ascites, the timing of its commencement should be decided taking various complications into consideration.