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Ultrasonically guided insertion of a peritoneo-gastric shunt in patients with malignant ascites
T Lorentzen1, L Sengeløv, C P Nolsøe
1Department of Ultrasound, Herlev Hospital, University of Copenhagen, Denmark.
Purpose:
A new method for internal drainage of malignant ascites is presented in 5 patients with symptomatic malignant ascites.
Material And Methods:
US-guided percutaneous gastrostomy and paracentesis were performed using the Seldinger technique. A 2.5-mm Cope-loop catheter was inserted in the fluid-filled stomach. In the lower abdomen the proximal part of a Denver peritoneo-venous shunt was introduced after dilation up to 4.8 mm. The pump chamber was sutured to the skin. The distal part of the Denver shunt was cut a few cm from the pump chamber and connected to the gastrostomy catheter. When pumping, ascites is shunted to the stomach lumen.
Results:
The insertion presented no complications, and all shunt systems initially functioned well. However, the shunts had to be removed within the first 2 weeks because of mechanical problems such as clotting, leakage, and peritoneal septum formation. No infections were reported.
Conclusion:
The peritoneo-gastric shunt may present a therapeutic alternative in selected patients, but the mechanical problems have first to be solved.