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Disseminated intravascular coagulation. Complication of LeVeen peritoneovenous shunts
Insights
Disseminated intravascular coagulation (DIC) is a risk after LeVeen shunt insertion for ascites. Monitoring for DIC is crucial for managing bleeding or clotting risks in patients undergoing this procedure.
Area of Science:
- Gastroenterology
- Hematology
- Nephrology
Background:
- Intractable ascites management often involves peritoneovenous shunts.
- LeVeen shunt insertion is a common surgical intervention for refractory ascites.
- Potential complications of shunts require careful consideration.
Purpose of the Study:
- To investigate the incidence and severity of disseminated intravascular coagulation (DIC) post-LeVeen shunt insertion.
- To evaluate the relationship between ascites infusion and DIC development.
- To emphasize the importance of monitoring for DIC in patients with shunts.
Main Methods:
- Observational study of five patients undergoing LeVeen shunt insertion for intractable ascites.
- Monitoring for disseminated intravascular coagulation (DIC) post-surgery.
- Interruption of shunts in cases of DIC.
- Analysis of DIC occurrence during trial ascites infusions.
Main Results:
- Three of five patients developed disseminated intravascular coagulation (DIC) after LeVeen shunt insertion.
- DIC episodes varied from life-threatening to asymptomatic.
- Shunt interruption resolved DIC in two patients.
- DIC also occurred during ascites infusion trials, even with modified procedures.
Conclusions:
- LeVeen shunt insertion for intractable ascites carries a risk of disseminated intravascular coagulation (DIC).
- Vigilant DIC monitoring is essential after shunt placement.
- Prompt management, including shunt interruption, can mitigate DIC complications and protect patients from hemorrhage or thrombosis.
Abstract:
Disseminated intravascular coagulation (DIC) occurred in three of five patients after insertion of a LeVeen shunt for intractable ascites. Four episodes of DIC in these patients ranged in severity from progressive and life-threatening to transient and asymptomatic. Interruption of the shunt in two patients stopped the DIC. Careful monitoring for DIC following shunt insertion allows rational decisions to protect the patient against life-threatening hemorrhage or thrombosis. Disseminated intravascular coagulation occurred in two patients during a trial intravenous infusion of ascites and occurred in one patient even when the surgical procedure was modified to minimize the volume and rate of the infused ascites.