A Case of Postoperative Refractory Ascites Successfully Treated by Peritoneovenous Shunt

Hisahiro Hosogi, Hiroshi Okabe, Kazutaka Obama and Yoshiharu Sakai

Department of Surgery, Graduate School of Medicine, Kyoto University

A 56-year-old man with a history of chronic type C hepatitis admitted due to advanced gastric cancer with esophageal invasion underwent neoadjuvant chemotherapy, followed by total gastrectomy with lower esophagus resection. Postoperatively, refractory massive ascites not controllable with diuretics necessitated concentrated ascites reinfusion therapy starting on postoperative day (POD) 43. After 12 treatment cycles, ascites decreased somewhat but remained refractory, necessitating Denver peritoneovenous shunt surgery on POD 88. Abdominal distention ceased and laboratory data improved markedly. He was discharged on POD 98. Numerous interventions for medically refractory ascites, such as concentrated ascites reinfusion therapy, peritoneovenous shunt, and transjugular intrahepatic portosystemic shunt, have been applied to relieve the symptoms of massive ascites. Few reports have been made of refractory postoperative ascites successfully treated by peritoneovenous shunt. For patients with refractory postoperative ascites with a background of cirrhosis, however, the efficacy and risk of treatment must be thoroughly understood to select appropriate intervention, and timing.

Key words
refractory ascites, peritoneovenous shunt, concentrated ascites reinfusion

Reprint requests
Hisahiro Hosogi Department of Surgery, Graduate School of Medicine, Kyoto University
54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507 JAPAN

Accepted
September 16, 2009

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