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Peritoneovenous Shunt for Intractable Ascites in Children: A Series of 4 Cases
Coralie Defert1, Jean-Baptiste Marret2, Florence Lacaille3
1INSERM (National Institute of Health and Medical Research) U1016, Université Paris-Descartes, Institut Cochin.
Insights
Peritoneovenous shunts (PVS) offer effective drainage for intractable pediatric ascites. Careful management is crucial to prevent complications like fat embolism and infection.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Devices
Background:
- Intractable ascites in children is rare, often linked to cirrhosis or lymphatic issues.
- Internal drainage via peritoneovenous shunt (PVS) is a potential rescue therapy.
Purpose of the Study:
- To evaluate the efficacy and safety of peritoneovenous shunt (PVS) placement in pediatric patients with intractable ascites.
Main Methods:
- Retrospective analysis of 4 pediatric patients (2 months to 15 years) who underwent Denver shunt placement between 2010-2020.
- Shunts drained ascites from the peritoneum to the venous system via the internal jugular vein.
Main Results:
- Immediate and efficient ascites drainage was achieved in all patients, lasting up to 9 years.
- Two major complications occurred: postoperative fat embolism and late-onset endocarditis.
- Fat embolism necessitated temporary shunt ligation; endocarditis followed subsequent abdominal surgery.
Conclusions:
- Peritoneovenous shunt (PVS) implementation can be a valuable option for refractory pediatric ascites.
- Pre-operative management of chylous ascites is vital to prevent fat embolism.
- Antibiotic prophylaxis is recommended for abdominal surgeries in patients with shunts.
Abstract:
Intractable ascites is a rare condition in children mainly caused by cirrhosis or lymphatic disorders. Internal drainage may be considered as rescue therapy. In our department, 4 patients ages from 2 months to 15 years old underwent a peritoneovenous shunt (PVS) placement between 2010 and 2020. The surgically inserted device was a pumping device that enabled to drain ascites from the peritoneum into the venous system via the internal jugular vein (Denver shunt, BD Company, NJ). Immediate efficient drainage was achieved in all cases and lasted up to 9 years. Two major complications occurred: a postoperative fat embolism requiring urgent temporary ligation of the shunt and endocarditis shortly after inguinal hernia repair performed 16 months after placement of the shunt. Implementation of a PVS may be a useful procedure in patients with refractory ascites. Chylous ascites should be drained and washed totally before activating the device to avoid fat embolism. Antibiotic prophylaxis is required when abdominal surgery is planned while the device is in place.
