Bizarre complications of peritoneovenous shunts

Implantable peritoneovenous shunts have facilitated the management of patients with medically intractable ascites. The more commonly reported complications occur with an incidence of 20-50%. Rare and problematic complications are becoming increasingly frequent. Two unusual complications, 1) progressive respiratory insufficiency and death secondary to pulmonary embolization of ascites fluid containing cholesterol crystals, and 2) shunt malfunction caused by the formation of a fibrous envelope around the venous catheter are presented. Pathogenesis, diagnosis and therapy of each of these unusual complications is discussed.