Complications of peritoneovenous shunt for malignant ascites

A peritoneovenous (PV) shunt was placed in eight patients with intractable malignant ascites. The shunt successfully controlled the ascites in six patients. The median survival time of the entire group was 2 months, with one patient alive at 22 months. Two of seven patients had secondary shunt failure: one from an unknown cause which could not be corrected by revision and another which was corrected by revision following removal of psammoma bodies in the valve. The complications of the shunt included transient edema (four patients), transient intravascular coagulation (four patients), and fever (two patients). Tumor embolization was suspected pathologically in two of eight patients although the ascitic fluid contained malignant cells in seven of eight patients. The PV shunt is a satisfactory palliative procedure for malignant ascites in the presence of adequate cardiac function and in the absence of urinary obstruction. The presence of bloody effusion or major intra-abdominal mass lesions contra-indicates a successful PV shunt. The acute adverse effets of the PV shunt (fever, fluid overload, and fulminant disseminated intravascular coagulation) may be prevented or minimized by preoperative fluid removal to obviate a major intravascular infusion of colloid and biologically active pyrogen and thromboplastin.