title: Peritoneovenous shunts for palliation of malignant ascites.
abstract: BACKGROUND
  Malignant ascites may produce a cluster of symptoms that include abdominal distention, early satiety, respiratory embarrassment, impaired mobility, and lethargy, and relief of these symptoms is often difficult to achieve. We report on the placement of peritoneovenous shunts (PVSs) in a group of patients with malignant ascites, with particular reference to the effectiveness and complications of the procedure.
  
  
  METHODS
  PVSs were inserted in 9 patients with malignant ascites after obtaining their informed consent. The patients were 6 men and 3 women with a median age of 59 years. All had previously been treated with vigorous diuretic therapy or repeated paracentesis or both. Shunt insertion was carried out via a percutaneous approach under local anesthesia.
  
  
  RESULTS
  The procedure was well tolerated by all patients. The abdominal distention resolved in all patients, and urine volume increased significantly, demonstrating that the PVS did not affect renal function. The platelet count was reduced, and prothrombin time was prolonged. Two patients had the complication of shunt occlusion, and both patients underwent shunt replacement. There were no lethal complications. Median survival time after PVS placement was 21 days (range, 10 approximately 90 days), and the shunt was functioning at the time of death with good control of ascites in all patients.
  
  
  CONCLUSIONS
  Malignant ascites produces troublesome symptoms for patients, who may live for some time. Placement of a PVS is a well-tolerated, relatively minor surgical procedure that can provide excellent control of ascites in most patients selected. The selection of optimal patients requires further study.
authors.affiliation: Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Japan. mamachan@nms.ac.jp
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Kouichi
authors.initials: K
authors.lastname: Bandou
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Shimizu
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kakinuma
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mizuguchi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Koho
authors.initials: K
authors.lastname: Akimaru
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
mesh_terms: D000368:Aged; D001201:Ascites / Q000209:etiology / Q000601:surgery*; D004067:Digestive System Neoplasms / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010536:Peritoneovenous Shunt / Q000379:methods; D016896:Treatment Outcome