Peritoneovenous shunts--devices of last resort

This study examines the usefulness of peritoneovenous shunts through a retrospective review of the charts of 16 patients who received this shunt at the University Hospital in Saskatoon up to May 1987. Fourteen shunts were placed for malignant ascites, 1 for alcoholic cirrhosis and 1 for nephrogenic ascites. All patients had symptoms related to abdominal pressure or dyspnea. Diuretics were most frequently used as initial management, and paracentesis was performed to relieve symptoms in all but one patient. However, a trial of sodium restriction was used in only eight patients, and only five of these trials lasted longer than 1 week. Thus, the adequacy of medical management was questionable. The death of one patient was directly attributable to the shunt, and the deaths of four others were suspected to be sequelae of surgery or shunting. Only five shunts were functioning at the time the patient died. In this study, the majority of the patients received little benefit from the peritoneovenous shunt.