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Disseminated intravascular coagulation following peritoneo-venous (LeVeen) shunt
Insights
Peritoneovenous shunts can cause disseminated intravascular coagulation (DIC) in patients with ascites. Monitoring coagulation profiles is crucial for assessing shunt function and potential bleeding risks.
Area of Science:
- Medical Science
- Surgical Innovation
- Hematology
Background:
- Intractable ascites is a common complication of liver disease.
- LeVeen shunts are used to manage ascites by diverting peritoneal fluid to the venous system.
- The impact of peritoneovenous shunts on postoperative coagulation requires further investigation.
Purpose of the Study:
- To determine the incidence, severity, and clinical significance of disseminated intravascular coagulation (DIC) after LeVeen shunt insertion.
- To assess the relationship between shunt function and coagulation abnormalities.
- To evaluate the utility of coagulation monitoring in the early postoperative period.
Main Methods:
- Ten LeVeen shunts were inserted in nine patients with intractable ascites.
- Coagulation studies were performed pre- and post-operatively.
- Shunt patency and clinical hemostasis were monitored.
Main Results:
- Two shunts failed to function, with no significant changes in coagulation profiles.
- Eight shunts had good initial flow, leading to coagulation profile deterioration consistent with DIC.
- Four patients showed clinical evidence of impaired hemostasis, with two requiring emergency shunt ligation; two died from bleeding.
- Shunt blockage or ligation resolved coagulation abnormalities.
- Four patients with continued shunt patency had elevated fibrin degradation products.
Conclusions:
- Adequate peritoneovenous shunt flow causes laboratory evidence of DIC, which can be clinically significant.
- Coagulation profile monitoring is a valuable index of shunt patency in the early postoperative phase.
- DIC may contribute to the high rate of spontaneous shunt blockage.
Abstract:
Ten LeVeen shunts were inserted into nine patients with intractable ascites and coagulation studies were performed to determine the incidence, severity, and clinical importance of disseminated intravascular coagulation (DIC) in the initial post-operative period. Two of the shunts failed to function in the immediate post-operative period and the clotting profiles of these patients were unchanged by surgery. The remaining shunts had good initial flow and in all patients there was a deterioration in the coagulation profile consistent with DIC. In four of these patients this was associated with clinical evidence of impaired haemostasis which required surgical ligation of the shunt in two as an emergency measure. The other two patients died as a direct consequence of their bleeding. Of the eight initially patent shunts, one blocked spontaneously and three others were surgically ligated in the early post-operative period. The clotting abnormalities of all of these patients returned to pre-operative levels with the cessation of flow through the shunts. Four patients had continued shunt patency during their hospital stay and, in all, titres of fibrin degradation products remained elevated. The conclusions reached are that adequate flow through the peritoneovenous shunt causes laboratory evidence of DIC in all patients and this can be of major clinical importance; that monitoring of the coagulation profile is a good index of continued shunt patency at least in the early post-operative period; and that DIC may account for the high spontaneous blockage rate.