Study ofPeritoneovenous Shunt (Denver Shunt) Its Role in Management of Refractory Ascites and Its Complications

Abstract

Ascites is the most common complication of patients with cirrhosis and its development constitutes the first and most important manifestation of the disease. With disease progression, patients with advanced cirrhosis and severe urinary sodium retention develop refractory ascites, a condition in which patients do not respond to diuretics or develop severe side effects that prohibit their use. Refractory ascites is generally thought to presage death with relatively small !-year and 2-year rates of survival. Malignant ascites can ans<: as a complication of any

malignancy with intraperitoneal involvement and can be very troublesome for some patients and lasting symptomatic control is often not achieved. Intractable ascites due to cirrhosis and malignancy have significant morbidity which include anorex1a, nausea, vomiting, pain, abdominal distension, impaired mobility and respiratory embarrassment that may be severe and disabling. Quality of life may be markedly compromised. Intractable ascites is an incapacitating condition for the patient and a difficult management problem for the physician. Medical treatment of ascites with diuretics depletes the circulating volume in an attempt to draw fluid from the peritoneal cavity back into the circulation.