Drainage Of Ascites Research Articles

Incidence of Hyponatremia in Patients With Indwelling Peritoneal Catheters for Drainage of Malignant Ascites

Indwelling peritoneal catheters (IPCs) are frequently used to drain tense, symptomatic, malignant ascites. Large-volume drainage may lead to hyponatremia owing to massive salt depletion. To date, no studies have examined the epidemiology of hyponatremia after placement of an IPC. To evaluate the incidence of hyponatremia after IPC placement, the risk factors associated with its development, and how it is managed. This cohort study retrospectively reviewed the medical records of 461 patients who had IPCs placed during the period between 2006 and 2016 at a tertiary care hospital in Boston, Massachusetts, of whom 309 patients met the inclusion criteria. Data analysis was performed from June to November 2019. Main outcomes were the incidence of hyponatremia (with a serum sodium level <135 mEq/L) after IPC placement, the risk factors for its development, and how it was managed. We also examined the clinical course of a subset of 21 patients with hypovolemic hyponatremia. Of the 309 eligible patients with laboratory results both before IPC placement and 2 days or more after IPC placement, 189 (72.1%) were female, and the mean (SD) age was 59 (12) years. The overall incidence of hyponatremia after IPC placement was 84.8% (n = 262), of whom 21 patients (8.0%) had severe hyponatremia. The mean (SD) decrease in serum sodium level before vs after IPC placement was 5 (5.1) mEq/L and decreased by 10 mEq/L or more among 52 patients (16.8%). Patients with hyponatremia prior to IPC placement had an 8-fold higher adjusted odds of having persistent hyponatremia after IPC placement (odds ratio, 7.9; 95% CI, 2.9-21.7). Patients with hepatopancreatobiliary malignant neoplasms were more likely to develop hyponatremia (78 of 262 patients with hyponatremia [29.8%] vs 7 of 47 patients without hyponatremia [14.9%]). Hyponatremia was either unrecognized or untreated in 189 patients (72.1%). Although the placement of an IPC is often a palliative measure, hyponatremia is common and is often untreated or unrecognized. Patients at highest risk, such as those with hyponatremia at baseline and those with hepatopancreatobiliary malignant neoplams, should be evaluated carefully prior to IPC placement and may warrant closer monitoring after placement. In all cases, hyponatremia should be evaluated and managed within the context of a patient's overall goals of care.

Perforation of the ascending colon during implantation of an indwelling peritoneal catheter: a case report

BackgroundTunneled peritoneal drainage catheters are described as an effective and relatively safe method in the management of malignant and non-malignant refractory ascites. Therapeutic advantages, linked to their use, are self-management of ascites and palliative care at home. Complications occur rarely. We describe an ascending colon perforation after implantation of a peritoneal drainage in a patient with refractory ascites due to liver cirrhosis.Case presentationThe 68-year-old male was admitted to the intensive care unit due to severe community acquired pneumonia. The ascites drainage was inserted in order to reduce the intra-abdominal pressure and enable appropriate ventilation. A few hours later, bowel content could be detected in the tube and an abdominal computed tomography confirmed the intestinal perforation. Notably, there was no pneumoperitoneum and peritonitis had not yet set in. The catheter was removed during an emergency laparotomy and sutured closure of both perforation sites was performed.ConclusionPatients with septated ascites and intraperitoneal adhesions are at potential higher risk of bowel perforation during implantation of an indwelling peritoneal catheter. A mini-laparotomy is, therefore, necessary in order to ensure safe implantation and positioning of the catheter in those cases.

Hyponatremia Is Common After Indwelling Catheter Drainage of Malignant Ascites

Hyponatremia Is Common After Indwelling Catheter Drainage of Malignant Ascites

EUS-guided drainage of localized malignant ascites with Pancreatic cancer: A case report

EUS-guided drainage of localized malignant ascites with Pancreatic cancer: A case report

Use of indwelling pleural/peritoneal catheter in the management of malignant ascites: a retrospective study of 48 patients.

Patients suffering from malignant ascites usually require repeated large volume paracentesis (LVP) for symptomatic relief. This often requires hospital admission and has inherent risks. To report the first Australian experience of placing tunnelled indwelling peritoneal catheters (IPeC) for management of recurrent malignant ascites. A retrospective study was conducted of tunnelled IPeC use in patients with symptomatic malignant ascites in four hospitals in Western Australia (from 2010 to 2018). Procedure data, success rate and safety profile were collected from a database. Forty-eight patients (median age 65 years; female 56%) underwent 51 peritoneal catheter insertion procedures that were performed mostly by pleural specialists. The majority of patients (96%) had prior LVP (median two drainages, interquartile range (IQR) 1-4) before IPeC insertion. The IPeC was inserted successfully under ultrasound guidance in all patients. The median length of hospital stay for IPeC insertion and initial ascites drainage was 2 days (IQR 2-3 days) and most patients (96%) did not require further paracentesis after IPeC placement. The majority (96%) of patients experienced relief from ascites symptoms after catheter insertion. Most IPeC-related adverse events were self-limiting, including pain (in 25% cases), transient hypotension after initial fluid drainage (10%), peritoneal fluid leakage (10%), bacterial peritonitis (8%), fluid loculation (2%) and catheter dislodgement (2%). Six (12%) patients had IPeC removed. All patients with bacterial peritonitis responded to antibiotics and one required catheter removal. Use of tunnelled IPeC improves symptoms and can minimise further invasive drainage procedures in patients with symptomatic malignant ascites. Placement of IPeC was associated with a low rate of adverse events, most of which could be managed conservatively.

Malignant ascites drainage with indwelling abdominal catheters: can we predict and prevent infection complication?

Malignant ascites is an abnormal accumulation of fluid in the peritoneal cavity as a result of cancer. Its occurrence has been reported in numerous malignancies. Ascites is a sign of advanced disease and poor prognosis, with only 11% of patients surviving >6 months, except those with ovarian cancer. Patients with ascites experience numerous significant symptoms that deteriorate their quality of life. First-line interventions beyond treatment of the primary disease include dietary restriction, use of diuretics, and repeated paracentesis. Permanent insertion of catheters in the abdominal cavity is considered to avoid repeated paracenteses and multiple hospitalizations. Fluid drained from the peritoneal cavity can be directed evacuated outside the body, or directed to other body compartments. In the first case, evacuation of the ascitic fluid can be performed using percutaneous catheters inserted directly through the abdominal wall into the peritoneal cavity (e.g., peritoneal and venous catheters), or drains with a subcutaneous tunnel (e.g., PleurX, Tenckhoff, a peritoneal port) (1).

How to care for patients undergoing paracentesis for the drainage of ascites.

Ascites is the excessive accumulation of extracellular fluid within the peritoneal cavity, which usually develops as a result of cirrhosis of the liver. Paracentesis is the procedure for removing ascitic fluid from the transabdominal peritoneal cavity via a temporary ascitic drain. This article aims to support nurses in providing safe and effective care for patients undergoing paracentesis. • Paracentesis is used to reduce intra-abdominal pressure and to relieve the symptoms of abdominal ascites, such as severe abdominal distention, pain and dyspnoea (difficulty breathing). The removal of at least 5L of ascitic fluid is considered large-volume paracentesis.• The role of the nurse is usually to monitor the patient throughout the procedure, administer treatment as directed by the medical team and, depending on local policy, remove the drain at the end of the procedure.• Knowledge of the benefits and risks of this procedure is essential to provide safe, evidence-based care for patients undergoing paracentesis. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How reading this article will change your practice in caring for patients undergoing paracentesis.2. How this article could be used to educate patients who are due to undergo paracentesis.

Therapeutic results of Denver percutaneous peritoneovenous shunt in cancer patients with malignant ascites.

Intractable ascites secondary to malignant disease deteriorates patients' quality of life. The purpose of this study was to evaluate the safety and efficacy of percutaneous peritoneovenous (Denver) shunt in treating intractable malignant ascites in cancer patients. Thirty-five patients who had undergone Denver peritoneovenous shunt for the treatment of ascites associated with malignant tumor from October 2014 to 2017 were retrospectively analyzed. The demographic characteristics, laboratory values, and complications were recorded. Univariate and multivariate logistic regression analyses were performed. The sites of primary tumor were pancreatic cancer in 19 patients, bile duct cancer in 8, gallbladder cancer in 5, breast cancer in 2, and peritoneal malignant mesothelioma in 1. Palliation of abdominal distention was achieved in 29 patients (82.9%). Postoperative complications of Grade 2 or higher were seen in 11 patients (31.4%), and Grade 5 complications were observed in three patients (8.6%). Patients with a high American Society of Anesthesiologists (ASA) grade and high ascites drainage volume had a significantly higher incidence of postoperative complications than a low ASA grade and low ascites drainage volume, and a multivariate logistic analysis showed that the intraoperative ascites drainage volume was an independent risk factor for all complications. The Denver shunt for malignant ascites is useful for improving patients' quality of life if the indications are selected properly. Drainage of intraoperative ascites was a risk factor for postoperative complications after the Denver shunt technique in cancer patients with malignant ascites. Further experience and discussion are necessary to establish the patient selection criteria.

Continuous transabdominal drainage of ascites for management of hyperreactio luteinalis with massive ascites

Continuous transabdominal drainage of ascites for management of hyperreactio luteinalis with massive ascites

Management of drainage for malignant ascites in gynaecological cancer.

Ascites is the accumulation of fluid within the abdominal cavity. Most women with advanced ovarian cancer and some women with advanced endometrial cancer need repeated drainage for ascites. Guidelines to advise those involved in the drainage of ascites are usually produced locally and are generally not evidence-based. Managing drains that improve the efficacy and quality of the procedure is key in making recommendations that could improve the quality of life (QoL) for women at this critical period of their lives. To evaluate the effectiveness and adverse events of different interventions for the management of malignant ascites drainage in the palliative care of women with gynaecological cancer. We searched CENTRAL, MEDLINE, and Embase to 4 November 2019. We checked clinical trial registries, grey literature, reports of conferences, citation lists of included studies, and key textbooks for potentially relevant studies. We included randomised controlled trials (RCTs) of women with malignant ascites with gynaecological cancer. If studies also included women with non-gynaecological cancer, we planned to extract data specifically for women with gynaecological cancers or request the data from trial authors. If this was not possible, we planned to include the study only if at least 50% of participants were diagnosed with gynaecological cancer. Two review authors independently selected studies, extracted data, evaluated the quality of the included studies, compared results, and assessed the certainty of the evidence using Cochrane methodology. In the original 2010 review, we identified no relevant studies. This updated review included one RCT involving 245 participants that compared abdominal paracentesis and intraperitoneal infusion of catumaxomab versus abdominal paracentesis alone. The study was at high risk of bias in almost all domains. The data were not suitable for analysis. The median time to the first deterioration of QoL ranged from 19 to 26 days in participants receiving paracentesis alone compared to 47 to 49 days among participants receiving paracentesis with catumaxomab infusion (very low-certainty evidence). Adverse events were only reported among participants receiving catumaxomab infusion. The most common severe adverse events were abdominal pain and lymphopenia (157 participants; very low-certainty evidence). There were no data on the improvement of symptoms, satisfaction of participants and caregivers, and cost-effectiveness. Currently, there is insufficient evidence to recommend the most appropriate management of drainage for malignant ascites among women with gynaecological cancer, as there was only very low-certainty evidence from one small RCT at overall high risk of bias.

Successful treatment of hepatic lymphorrhea by percutaneous transhepatic lymphangiography followed by sclerotherapy using OK-432

BackgroundConventional lymphangiography cannot detect leakage sites of hepatic lymphatic vessels. Percutaneous transhepatic lymphangiography can be used to visualize leakage sites, and once the leakage site has been confirmed, effective sclerotherapy can be performed.Case presentationA rare case of intractable hepatic lymphorrhea due to injury of the hepatoduodenal ligament following pancreaticoduodenectomy is reported. Drainage of massive ascites from the drainage tube continued after surgery. Percutaneous transhepatic lymphangiography visualized the intrahepatic lymphatic vessels and the leakage site at the hepatic hilum. An 8-Fr drainage catheter was inserted adjacent to the leakage point under fluoroscopic computed tomography guidance. Repeated sclerotherapy using intraperitoneal administration of OK-432 (picibanil) through the catheter was performed, which exposed the leakage site, and control of the ascites was finally achieved.ConclusionsTo the best of our knowledge, this is the first successful case of detection of a leakage site using intrahepatic lymphangiography, followed by sclerotherapy using OK-432.

Continuous low flow ascites drainage through the urinary bladder via the Alfapump system in palliative patients with malignant ascites

BackgroundMalignant Ascites (MA) is a therapeutic dilemma significantly impairing patients’ quality of life (QoL). The Sequana Medical alfapump System (AP), a subcutaneous, externally rechargeable, implantable device, continually draining ascites via the urinary bladder, has been well established in liver cirrhosis, but not yet in MA. The AP-system was evaluated in cancer patients in reducing the need for large volume paracentesis (LVP).MethodsA retrospective multicentre evaluation of all eligible patients who received an AP for MA-palliation was performed. AP was evaluated for its ability to reduce LVP and cross-correlated with adverse events (AE), survival and retrospective physician-reported QoL.ResultsSeventeen patients with median age of 63 years (range: 18–81), 70.6% female, across 7 primary tumour types were analysed. Median duration of AP-implantation was 60 min (range: 30–270) and median post-implantation hospital stay: 4 days (range: 2–24). Twelve protocol-defined AE occurred in 5 patients (29.4%): 4 kidney failures, 4 pump/catheter-related blockages, 3 infections/peritonitis and 1 wound dehiscence. Median ascitic volume (AV) pumped daily was 303.6 ml/day (range:5.6–989.3) and median total AV drained was 28 L (range: 1–638.6). Median patient post-AP-survival was 111 days (range:10–715) and median pump survival was 89 days (range: 0–715). Median number of paracenteses was 4 (range: 1–15) per patient pre-implant versus 1 (range: 0–1) post-implant (p = 0.005). 71% of patients were reported to have an improvement of at least one physician reported QoL-parameters.ConclusionsAP appears to be effective in palliating patients with MA by an acceptable morbidity profile. Its broader implementation in oncology services should be further explored.Trial registrationNCT03200106; June 27, 2017.

MEIGS SYNDROME PRESENTING AS A LYMPHOCYTIC EXUDATIVE PLEURAL EFFUSION

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Meigs syndrome is defined by the presence of a benign fibromatous ovarian tumor with associated pleural effusion and ascites that resolve once the tumor is resected. Current literature describes the pleural effusion as an exudate and occurring in conjuncture with ascites. However, characterization by cell differential is lacking. We report a patient with a unilateral lymphocytic pleural effusion as the presenting feature of Meigs syndrome. CASE PRESENTATION: The patient is a 34-year-old woman with history of asthma, tobacco use, and uterine fibroids who presented with progressive dyspnea on exertion with chest tightness and cough for 4 months. She denied fevers, chills, night sweats, or tuberculosis risk factors, and was treated for pneumonia 5 months prior to presentation. On exam, heart rate was 109 bpm, SpO2 100% on room air, and lung sounds were decreased at both bases. Chest x-ray revealed a moderate right pleural effusion, confirmed on chest CT which also noted small ascites that was not clinically apparent on exam. Thoracentesis removed 2.1L of a lymphocyte predominant exudative fluid (protein 5.3 g/dL, LDH 294 U/L, WBC 325 /UL, 41% lymphocytes, 29% neutrophils, 24% macrophages, RBC 160,000 /UL, ADA 7.6 U/L, bacterial and AFB culture negative, cytology negative; serum LDH 138 U/L, serum protein 6.9 g/dL). Patient did not follow up until she represented to pulmonary clinic 3 months later with recurrent dyspnea on exertion. Exam revealed dullness at the right base consistent with recurrent pleural effusion as well as significant abdominal distension with fluid wave. Repeat thoracentesis removed 1.5L of dark serosanginuous fluid, with WBC 329 /UL, 3% neutrophils, 47% lymphocytes, RBC 508,750 /UL and chemistries again consistent with an exudate. A malignancy work-up was pursued and revealed an 8.8 cm ovarian/adnexal mass consistent with a dermoid. She underwent a left salpingo-oophorectomy and drainage of 4L bloody ascites. Pathology revealed a mature cystic teratoma. The patient had rapid respiratory improvement post-operatively without evidence of recurrence in pleural effusion at follow up. Overall her presentation was consistent with Meigs syndrome. DISCUSSION: Existing data regarding Meigs syndrome is limited with lack of classification of pleural effusion by cell counts and types. Pleural effusion is speculated to result from ascites translocation across the diaphragm, however the small amount of ascites on initial presentation of this patient was not clinically apparent to help guide diagnosis. CONCLUSIONS: To our knowledge this is the first reported case of a lymphocyte predominant exudative effusion caused by Meigs syndrome and it is an example of pleural effusion as the presenting clinical finding in a Meigs syndrome patient. Meigs syndrome, although uncommon, should therefore be considered in the differential diagnosis for women with new lymphocytic exudative pleural effusion. Reference #1: Krenke R et al. Pleural Effusion in Meigs’ Syndrome – transudate or exudate? Systemic Review of the Literature. Medicine. 2015. 94 (49): e2114 DISCLOSURES: No relevant relationships by Kevin Kovitz, source=Web Response No relevant relationships by Mateo Tole, source=Web Response No relevant relationships by Christen Vagts, source=Web Response

2374 Rare Microbiologic Etiologies of Spontaneous Bacterial Peritonitis

Introduction: Often regarded as a poor prognostic factor in ascites, spontaneous bacterial peritonitis (SBP) is usually caused by Gram negative rods (E. coli, K. pneumoniae) and Gram positive cocci (S. pneumoniae).This case report identifies 2 rare cases of SBP. CASE DESCRIPTION/METHODS: Case 1 A 59 yo M with h/o decompensated cirrhosis (ascites without SBP history, encephalopathy, and variceal bleed) due to HCV presented with an episode of fall requiring orthopedic procedures. Flapping tremor, mild icterus, anemia, thrombocytopenia, AKI, coagulopathy, hyperbilirubinemia, hypoalbuminemia, and MELD score of 18 were significant findings. Abdominal/pelvic CT revealed hydronephrosis, which was corrected with ureteral stent placement upon admission. While awaiting rehab placement, patient developed paralytic ileus, septic shock due to ceftriaxone susceptible E. coli bacteremia, upper GI bleed, hypernatremia, pancytopenia, worsening hepatic encephalopathy, and worsening ascites with PMN of 3062. Abdominal/pelvic CT revealed no bowel perforation or alternate peritonitis source. Initially covered with piperacillin/tazobactam (P/T) and vancomycin for 4 days, therapy was narrowed to ceftriaxone for the following 4 days. Unfortunately, ascitic culture revealed Eggerthella lenta on culture day 8 (susceptible to clindamycin, meropenem, amoxicillin/clavulanate); patient ultimately demised with multiorgan failure. Case 2 A 66 yo M with h/o HCV and alcoholic cirrhosis on ciprofloxacin SBP prophylaxis, HFrEF, PVD with non-healing ulcer, CKD, and COPD presented with abdominal distension for routine paracentesis. Patient requires 5 to 6 L of ascitic fluid drainage with albumin replacement every other week. Ascitic fluid revealed PMN of 384; ceftriaxone was administered for 5 days and patient was discharged on ciprofloxacin prophylaxis. Ascitic fluid drawn prior to discharge ultimately grew Paenibacillus barengoltzii. Patient was requested to return for repeat ascitic culture, which resulted negative. DISCUSSION: 1. E lenta and P. barengoltzii SBPs have not been previously described in literature; thus, both represent the first cases of each. A rare anaerobic intra-abdominal pathogen, E. lenta is associated with high mortality with P/T monotherapy. Paenibacillus species have not been studied in depth but are likely susceptible to third-generation cephalosporins. Gastroenterologists and internists managing similar cases may fail to identify these etiologies and appropriate treatment resulting in unfavorable outcomes.

Safety and Efficacy of Venting Gastrostomy in Malignant Bowel Obstruction: A Systematic Review

Malignant bowel obstruction (MBO) is a common manifestation in patients with advanced intra-abdominal malignancy. It is especially common with bowel or gynecological cancers and produces distressing symptoms, including nausea, vomiting, and pain. Medical management options are less effective than decompressive strategies for symptom control. Surgery is the gold-standard treatment but is unsuitable for most patients with high complication rates. Consensus guidelines recommend nonsurgical management with a venting gastrostomy in those unsuitable for surgery or for whom medical management is ineffective. The aim of this systematic review is to establish the safety and efficacy of percutaneous venting gastrostomy in relieving symptoms of MBO. Twenty-five studies were included in this review comprising 1194 patients. Gastrostomy insertion was successful at first attempt in 91% of cases and reduction in symptoms of nausea and vomiting was reported in 92% of cases. Mean survival following the procedure ranged from 35 to 147 days. Major complications were rare, with most complications classed as minor wound infections or leakage of fluid around the tube. Studies suggest that the presence of ascites is not an absolute contraindication to the insertion of percutaneous venting gastrostomy in patients with MBO; however, these studies lack longitudinal outcomes and complication rates related to this. However, it is reasonable to suggest that ascitic drainage is performed to reduce potential complications. There is a relative lack of good quality robust data on the utilization of percutaneous venting gastrostomy in MBO, but overall, the combination of being a safe and efficacious procedure alongside the known complication profile suggests that it should be considered a suitable management option.

Verification of serum albumin elevating effect of cell-free and concentrated ascites reinfusion therapy for ascites patients: a retrospective controlled cohort study

Cell-free and concentrated ascites reinfusion therapy (CART) is frequently used to treat refractory ascites in Japan. However, its efficacy remains unclear. This controlled cohort study verified the serum albumin elevating effect of CART by comparisons with simple paracentesis. Ascites patients receiving CART (N = 88) or paracentesis (N = 108) at our hospital were assessed for the primary outcome of change in serum albumin level within 3 days before and after treatment. A significantly larger volume of ascites was drained in the CART group. The change in serum albumin level was +0.08 ± 0.25 g/dL in the CART group and −0.10 ± 0.30 g/dL in the paracentesis group (P < 0.001). The CART – paracentesis difference was +0.26 g/dL (95%CI +0.18 to +0.33, P < 0.001) after adjusting for potential confounders by multivariate analysis. The adjusted difference increased with drainage volume. In the CART group, serum total protein, dietary intake, and urine volume were significantly increased, while hemoglobin and body weight was significantly decreased, versus paracentesis. More frequent adverse events, particularly fever, were recorded for CART, although the period until re-drainage was significantly longer. This study is the first demonstrating that CART can significantly increase serum albumin level as compared with simple paracentesis. CART represents a useful strategy to manage patients requiring ascites drainage.

Establishing an indwelling peritoneal catheter as a standard procedure for hospitalized patients with ascites: Retrospective data on feasibility, effectiveness and safety.

The use of an indwelling peritoneal catheter system in hospitalized patients with ascites could facilitate patient management by the prevention of repetitive abdominal paracentesis. Despite these possible benefits, the use of indwelling catheters is not widely established. This retrospective study aimed to evaluate the feasibility, effectiveness and safety of the use of an indwelling catheter for ascites drainage in the clinical routine. This retrospective study included all indwelling peritoneal catheter placements in our department in hospitalized patients with cirrhosis between 2014 and 2017. A total of 324 indwelling catheter placements for ascites in 192 hospitalized patients with cirrhosis were included. The catheter (7F, 8 cm) was placed ultrasound-assisted bed-side on the hospital ward. The technical success rate of the catheter placement was 99.7% (323/324). In 17.5% (64/324) the catheter was placed to optimize ascitic drainage prior to an abdominal intervention (e.g. transjugular intrahepatic portosystemic shunt). The median time of catheter retention was 48 hours (8-168 hours) and the median cumulative amount of drained ascites 8000 ml (550-28,000). The most common adverse event was acute kidney injury (49/324, 15.1%); the risk was particularly higher in patients with a Model for End-Stage Liver Disease (MELD) score ≥ 16 (p = 0.028; odds ratio 2.039). Ascitic fistula after catheter removal was observed in 9.6% (31/324). Catheter-related infections occurred in 4.3% (14/324), and bleeding was documented in three cases (0.8%) with one major bleeding (0.3%). The placement of an indwelling catheter for repetitive ascitic drainage in hospitalized patients with cirrhosis can be established in the clinical routine, facilitating patient management. High-MELD patients especially have to be monitored for acute kidney injury.

Dialytic peritoneal ultrafiltration versus large-volume paracentesis in the treatment of marked ascites in cirrhotic patients

Background and aim: Ascites in liver cirrhosis is associated with a poor prognosis and impairment of the quality of life. The clinical efficacy and safety of large-volume paracentesis in comparison to dialytic peritoneal ultrafiltration in the treatment of marked ascites were evaluated. Patients and methods: A total of 96 cirrhotic patients with marked ascites were divided into two groups: group I 48 patients treated with dialytic ultrafiltration group IIa 31 patients treated with LVP without albumin and IIb 17 patients treated with LVP plus albumin infusion. Results: Mean arterial pressure of patients in the studied groups show significant decrease immediately after the different procedures and start to rise within 24 hours and reach readings similar to those before ascites drainage especially with peritoneal ultrafiltration. Improvement in plasma albumin concentration has been reported after dialytic ultrafiltration. There is statistically significant decrease in serum creatinine after 48 hours of the different treatments. The average volume of ascites removed was (9.04 ± .04) in the dialytic ultrafiltration group versus (4.45 ± 0.51) in large volume paracentesis without albumin group and (6.06 ± 0.83) in large-volume paracentesis plus albumin infusion. After treatment all patients experienced a relief of ascites which is better with larger amounts of fluids removed as occurred in dialytic ultrafiltration group. Conclusion: Dialytic ultrafiltration is an effective and relatively safe alternative to large-volume paracentesis in the treatment of marked ascites in cirrhotic patients. Blood pressure is well maintained, kidney functions are preserved. Dialytic ultrafiltration has the advantages of cost and time saving and avoidance of blood-borne infection associated with intravenous transfusion of blood products such as albumin.

Somatostatin Therapy in Patients with Massive Ascites After Liver Transplantation.

BackgroundPatients with massive ascites (MA) after liver transplantation (LT, defined here as daily ascitic drainage more than 1000 ml per day for more than 7 days after liver transplantation) are at increased risks of infection, hypoalbuminemia, graft loss, and even mortality. The aim of this retrospective cohort study was to investigate the effects of somatostatin on patients with MA after LT.Material/MethodsTwenty-eight patients with liver cirrhosis or hepatocellular carcinoma who underwent LT complicated by MA postoperatively were included. Ten participants were receiving somatostatin therapy. The postoperative course and adverse drug effects were investigated. Daily postoperative ascitic drainage and urine output were also recorded and compared to those in the non-somatostatin group.ResultsThe somatostatin group had significantly less ascites drainage after LT compared to the non-somatostatin group (p=0.002). Urine output was significantly increased after somatostatin administration (p<0.001). No serious adverse effects influencing graft function or fatal complications occurred after somatostatin therapy.ConclusionsSomatostatin treatment is beneficial for the management of MA after liver transplantation.

Permanent peritoneal ports for the management of recurrent malignant ascites: a retrospective review of safety and efficacy.

Large volume paracentesis is effective in relieving the symptoms of malignant ascites, but frequent procedures are often required. Permanent peritoneal ports are an alternative to repeated procedures. We describe our experience with the use of peritoneal ports in patients at Middlemore Hospital (Auckland, New Zealand) who had a port inserted for the drainage of malignant ascites. Twenty-eight ports were inserted in 26 patients and accessed a total of 257 times with acceptably low rates of complications including cellulitis, peritonitis and wound dehiscence.