Infectious complications of the peritoneovenous shunt

The peritoneovenous shunt has been recently advocated to relieve massive ascites refractory to medical therapy. Several complications of the shunt have been described but the incidence of infection has not been elucidated. We reviewed the records of all patients undergoing peritoneovenous shunt at the Emory University Affiliated Hospitals from 1975 to 1980. Eighty-five peritoneovenous shunts were done in 56 patients. Eighteen of the shunt insertions (21%) were followed by a major infection--eight bacteremias, eight peritonitis, and nine wound infections. Most infections were caused by aerobic gram-negative bacilli or Staphylococcus aureus. Fever was common (62%) in the immediate postoperative period but was not clearly related to infection, or the administration of antibiotics or antipyretics. Shunt removal appeared to be necessary in treating bacteremic patients but not in patients with only peritonitis or wound infections. Infection is a common complication of the peritoneovenous shunt and may limit its usefulness.