title: Management of medically refractory ascites.
abstract: BACKGROUND
  Medically refractory ascites is a clinical entity for which there exists few effective therapeutic options. Available treatment modalities include diuresis and sodium restriction, peritoneovenous shunt, liver transplant, transjugular intrahepatic portosystemic shunts and surgical shunts, and large-volume paracentesis. Herein we review the current therapeutic options for medically refractory ascites focusing on indications, benefits, and drawbacks of each specific therapy.
  
  
  METHODS
  Data and recommendations are based on the authors' cumulative experience with complicated cirrhotic and cancer patients and on past and current literature addressing intractable ascites.
  
  
  CONCLUSIONS
  The absence of a single, effective therapy in the management of refractory ascites speaks to the complex nature of this complication. Although most patients will respond to medical management, thoughtful application of available therapeutic options in patients who fail, as described herein, not only makes decisions regarding their care easier but also provides the best palliation in a vexing clinical scenario.
authors.affiliation: Division of Surgical Oncology, Ohio State University, N924 Doan Hall, 410 W. 10th Avenue, Columbus, OH 43210, USA. zervos.2@OSU.edu
authors.forename: E E
authors.initials: EE
authors.lastname: Zervos
authors.forename: A S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D001201:Ascites / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications