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. 2011 Jan 27;3(1):16-20.
doi: 10.4240/wjgs.v3.i1.16.

Peritoneovenous shunt for intractable ascites due to hepatic lymphorrhea after hepatectomy

Yoshihiro Inoue  1 , Michihiro Hayashi, Fumitoshi Hirokawa, Atsushi Takeshita, Nobuhiko Tanigawa
Affiliations

Peritoneovenous shunt for intractable ascites due to hepatic lymphorrhea after hepatectomy

Yoshihiro Inoue et al. World J Gastrointest Surg. .

Abstract

A peritoneovenous shunt has become one of the most efficient procedures for intractable ascites due to liver cirrhosis. A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented. A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection. After hepatectomy, a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy, including numerous infusions of albumin and plasma protein fraction and administration of diuretics. Since the patient's general condition deteriorated, based on the diagnosis of intractable hepatic lymphorrhea, a subcutaneous peritoneovenous shunt was inserted. The patient's postoperative course was uneventful and the ascites decreased rapidly, with serum total protein and albumin levels and hepatic function improving accordingly. For intractable ascites due to hepatic lymphorrhea after hepatectomy, we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.

Keywords: Hepatic lymphorrhea; Hepatocellular carcinoma; Intractable ascites; Peritoneovenous shunt; Surgical procedure.

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Figures

Figure 1
Figure 1
Preoperative abdominal computed tomography during angiography. This computed tomography reveals low density areas indicating two hepatocellular carcinoma nodules (arrow, arrowhead) of about 1.3 and 3 cm in diameter, in liver segments 8 (A) and 4 (B).
Figure 2
Figure 2
Serial changes in serum prothrombin time (%), creatinine (g/dL), total protein (g/dL), and albumin (g/dL). The arrow indicates intravenous infusion of 5 g of albumin. The arrowhead indicates the time of the placement of the peritoneovenous shunt (PVS). Note that the PVS placement resulted in dramatic improvement of these parameters which was not attainable by medical treatment.
See this image and copyright information in PMC

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