Failure of ascitic fluid replacement for prevention of coagulopathy post peritoneovenous shunt. Case report

A case of successive coagulopathies post peritoneovenous shunt in the same patient is presented. These coagulopathies occurred after a LeVeen valve insertion with ascitic fluid evacuation, and after reopening the shunt with ascitic fluid evacuation, with the peritoneal cavity washed and replaced with normal saline solution. This case illustrates the fact that peritoneal lavage and the replacement of the ascites with normal saline decrease the severity of the coagulopathy but do not prevent it completely. Peritoneal lavage and ascitic fluid replacement when a LeVeen valve is inserted, should be performed in selected cases, especially those who had a recently treated bacterial peritonitis.