{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T20:15:16Z","timestamp":1765656916955,"version":"3.48.0"},"reference-count":20,"publisher":"BMJ","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1985,10]]},"abstract":"<jats:p>A prospective analysis of the morbidity and mortality after peritoneovenous shunting was carried out in 25 patients who had a total of 27 shunts for refractory ascites. Major complications were limited to the patients in whom ascites was secondary to hepatic rather than peritoneal disease. Immediate postoperative complications followed 17 out of the 23 shunts carried out in patients with liver disease and included septicaemia (two), profound hypotension (two), pulmonary oedema (one), and clinically evident disseminated intravascular coagulation (14). Long term morbidity was again limited to the patients with liver disease and included chronic shunt infection (two) and major venous thrombosis (two). Shunt associated mortality was only seen in the patients with liver disease. Despite late shunt blockage in five long term survivors with alcoholic liver disease fluid retention was easily controlled by simple medical means probably because of improved liver function associated with abstinence from alcohol. It is concluded that: (1) patients with hepatic and malignant ascites respond differently to the insertion of a peritoneovenous shunt; (2) Shunt patency should be monitored regularly in patients with liver disease and, because of the potential for septic and thrombotic complications, if blocked the shunt should be removed and; (3) because of the morbidity and mortality of peritoneovenous shunt surgery in patients with liver disease and refractory ascites, an alternative mode of therapy, such as repeated ultrafiltration and reinfusion of ascitic fluid, may be a more effective initial therapeutic approach especially in patients in whom there is a reversible element to their underlying liver disease.<\/jats:p>","DOI":"10.1136\/gut.26.10.1070","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"1070-1073","source":"Crossref","is-referenced-by-count":35,"title":["Morbidity and mortality after peritoneovenous shunt surgery for refractory ascites."],"prefix":"10.1136","volume":"26","author":[{"given":"D","family":"Rubinstein","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I","family":"McInnes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F","family":"Dudley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1985,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/0016-5085(79)90273-7","article-title":"The renal and hemodynamic effects of the peritoneovenous shunt for intractable hepatic ascites","volume":"77","author":"Blendis, L.M.; Greig, P.D.; Langer, B.; Baigrie, R.S.; Ruse, J.; Taylor, B.R.","year":"1979","unstructured":"Blendis LM, Greig PD, Langer B, Baigrie RS, Ruse J, Taylor BR. The renal and hemodynamic effects of the peritoneovenous shunt for intractable hepatic ascites. Gastroenterology 1979; 77: 250-7.","journal-title":"Gastroenterology"},{"key":"ref_2","first-page":"119","article-title":"Renal and hemodynamic effects of the peritoneovenous shunt","volume-title":"Long term effects. Gastroenterology 1981; 80","author":"Greig, P.D.; Blendis, L.M.; Langer, B.; Taylor, B.R.; Colapinto, R.F.","unstructured":"Greig PD, Blendis LM, Langer B, Taylor BR, Colapinto RF. Renal and hemodynamic effects of the peritoneovenous shunt. II: Long term effects. Gastroenterology 1981; 80: 119-25."},{"key":"ref_3","first-page":"583","article-title":"Role of the peritoneovenous shunt in the management of ascites and the hepatorenal syndrome","volume-title":"The kidney in liver disease","author":"Epstein, M.","year":"1983","unstructured":"Epstein M. Role of the peritoneovenous shunt in the management of ascites and the hepatorenal syndrome. In: Epstein M. ed. The kidney in liver disease. New York, Amsterdam, Oxford: Elsevier Biomedical, 1983; 583-600."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/0002-9610(80)90241-X","article-title":"Complications after peritoneovenous shunting for ascites","volume":"139","author":"Greig, P.D.; Langer, B.; Blendis, L.M.; Taylor, B.R.; Glynn, M.F.X.","year":"1980","unstructured":"Greig PD, Langer B, Blendis LM, Taylor BR, Glynn MFX. Complications after peritoneovenous shunting for ascites. Am J Surg 1980; 139: 125-31.","journal-title":"Am J Surg"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1002\/bjs.1800600817","article-title":"Transection of the oesophagus for bleeding oesophageal varices","volume":"60","author":"Pugh, R.N.H.; Murray-Lyon, I.M.; Dawson, J.L.; Pietroni, M.C.; Williams, R.","year":"1973","unstructured":"Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60: 646-9.","journal-title":"Br J Surg"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1097\/00000658-197702000-00002","article-title":"Radionuclide assessment of Le Veen shunt patency","volume":"185","author":"Krichmer, N.; Hart, J.","year":"1977","unstructured":"Krichmer N, Hart J. Radionuclide assessment of Le Veen shunt patency. Ann Surg 1977; 185: 145-6.","journal-title":"Ann Surg"},{"key":"ref_7","first-page":"557","article-title":"Current status of the peritoneovenous shunt for the management of intractable ascites","volume":"22","author":"Fry, P.D.; Hallgren, R.; Robertson, M.E.","year":"1979","unstructured":"Fry PD, Hallgren R, Robertson ME. Current status of the peritoneovenous shunt for the management of intractable ascites. Can J Surg 1979; 22: 557-9.","journal-title":"Can J Surg"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1097\/00000658-197611000-00007","article-title":"Further experience with peritoneo-venous shunt for ascites","volume":"184","author":"HH, Le Veen; S, Wapnick; S, Grosberg; MJ, Kinney","year":"1976","unstructured":"Le Veen HH, Wapnick S, Grosberg S, Kinney MJ. Further experience with peritoneo-venous shunt for ascites. Ann Surg 1976; 184: 574-9.","journal-title":"Ann Surg"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1001\/jama.1977.03270290031021","article-title":"Le Veen HH. LeVeen continuous peritoneal-jugular shunt. Improvement of renal function in ascitic patients","volume":"237","author":"Wapnick, S.; Grosberg, S.; Kinney, M.","year":"1977","unstructured":"Wapnick S, Grosberg S, Kinney M, Le Veen HH. LeVeen continuous peritoneal-jugular shunt. Improvement of renal function in ascitic patients. JAMA 1977; 237: 131-3.","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/0002-9610(83)90039-9","article-title":"Management of malignant ascites with peritoneovenous shunting","volume":"145","author":"Reinhold, R.B.; Lokich, J.J.; Tomashefski, J.; Costello, P.","year":"1983","unstructured":"Reinhold RB, Lokich JJ, Tomashefski J, Costello P. Management of malignant ascites with peritoneovenous shunting. Am J Surg 1983; 145: 455-7.","journal-title":"Am J Surg"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1002\/bjs.1800700809","article-title":"Peritoneovenous shunts in the management of malignant ascites","volume":"70","author":"Souter, R.G.; Tarin, D.; Kettlewell, M.G.W.","year":"1983","unstructured":"Souter RG, Tarin D, Kettlewell MGW. Peritoneovenous shunts in the management of malignant ascites. Br J Surg 1983; 70: 478-81.","journal-title":"Br J Surg"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"774","DOI":"10.7326\/0003-4819-90-5-774","article-title":"Disseminated intravascular coagulation with the peritoneovenous shunt","volume":"90","author":"Harmon, D.C.; Demirjian, Z.; Ellman, L.; Fischer, J.E.","year":"1979","unstructured":"Harmon DC, Demirjian Z, Ellman L, Fischer JE. Disseminated intravascular coagulation with the peritoneovenous shunt. Ann Intern Med 1979; 90: 774-6.","journal-title":"Ann Intern Med"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1002\/ajh.2830110206","article-title":"The aggregation of human platelets by ascitic fluid: A possible mechanism for disseminated intravascular coagulation complicating Le Veen shunts","volume":"11","author":"Salem, H.H.; Koutts, J.; Handley, C.; Van der Weyden, M.B.; Dudley, F.J.; Firkin, B.G.","year":"1981","unstructured":"Salem HH, Koutts J, Handley C, Van der Weyden MB, Dudley FJ, Firkin BG. The aggregation of human platelets by ascitic fluid: A possible mechanism for disseminated intravascular coagulation complicating Le Veen shunts. Am J Haematol 1981; 11: 153-7.","journal-title":"Am J Haematol"},{"key":"ref_14","first-page":"412","article-title":"Coagulopathy of peritoneovenous shunts: studies on the pathogenic role of ascitic fluid collagen and value of antiplatelet therapy","volume-title":"Gut","volume":"24","author":"Salem, H.H.; Dudley, F.J.; Merrett, A.; Perkin, J.; Firkin, B.G.","year":"1983","unstructured":"Salem HH, Dudley FJ, Merrett A, Perkin J, Firkin BG. Coagulopathy of peritoneovenous shunts: studies on the pathogenic role of ascitic fluid collagen and value of antiplatelet therapy. Gut 1983; 24: 412-7."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/0002-9343(81)90151-0","article-title":"Peritonitis in cirrhotic patients with Le Veen shunts","volume":"71","author":"Wormser, G.P.; Hubbard, R.C.","year":"1981","unstructured":"Wormser GP, Hubbard RC. Peritonitis in cirrhotic patients with Le Veen shunts. Am J Med 1981; 71: 358-62.","journal-title":"Am J Med"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1136\/bmj.2.5909.11","article-title":"Renal lesions of subacute infective endocarditis","volume":"2","author":"Boulton-Jones, J.M.; Sissons, J.G.P.; Evans, D.J.; Peters, D.K.","year":"1974","unstructured":"Boulton-Jones JM, Sissons JGP, Evans DJ, Peters DK. Renal lesions of subacute infective endocarditis. Br Med J 1974; 2: 11-14.","journal-title":"Br Med J"},{"key":"ref_17","first-page":"921","article-title":"Nephrotic syndrome associated with bacteraemia after shunt operations for hydrocephalus","volume":"2","author":"Black, J.A.; Challacombe, D.M.; Ockenden, R.G.","year":"1965","unstructured":"Black JA, Challacombe DM, Ockenden RG. Nephrotic syndrome associated with bacteraemia after shunt operations for hydrocephalus. Lancet 1965; 2: 921-4.","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/S0016-5085(19)32137-7","article-title":"Detection of endotoxin in plasma and ascitic fluid of patients with cirrhosis: its clinical significance","volume":"73","author":"Tarao, K.; So, K.; Moroi, T.; Ikevchi, T.","year":"1977","unstructured":"Tarao K, So K, Moroi T, Ikevchi T, et al. Detection of endotoxin in plasma and ascitic fluid of patients with cirrhosis: its clinical significance. Gastroenterology 1977; 73: 539-42.","journal-title":"Gastroenterology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1136\/pgmj.51.598.564","article-title":"Treatment of ascites by reinfusion of concentrated peritoneal fluid. Review of 318 procedures in 210 patients","volume":"51","author":"Levy, V.G.; Opolon, P.; Pauleau, N.; Caroli, J.","year":"1975","unstructured":"Levy VG, Opolon P, Pauleau N, Caroli J. Treatment of ascites by reinfusion of concentrated peritoneal fluid. Review of 318 procedures in 210 patients. Postgrad Med J 1975; 51: 564-6.","journal-title":"Postgrad Med J"},{"key":"ref_20","first-page":"1296","article-title":"Treatment of resistant ascites by continuous ultrafiltration-reinfusion of ascitic fluid","volume":"117","author":"Villeneuve, J.P.; Thuot, C.; Marleau, D.; Joly, J.G.; Huet, P.M.; Viallet, A.","year":"1977","unstructured":"Villeneuve JP, Thuot C, Marleau D, Joly JG, Huet PM, Viallet A. Treatment of resistant ascites by continuous ultrafiltration-reinfusion of ascitic fluid. Can Med Assoc J 1977; 117: 1296-8.","journal-title":"Can Med Assoc J"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.26.10.1070","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T20:13:42Z","timestamp":1765656822000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.26.10.1070"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1985,10]]},"references-count":20,"journal-issue":{"issue":"10","published-online":{"date-parts":[[1985,10,1]]},"published-print":{"date-parts":[[1985,10]]}},"alternative-id":["10.1136\/gut.26.10.1070"],"URL":"https:\/\/doi.org\/10.1136\/gut.26.10.1070","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"type":"print","value":"0017-5749"},{"type":"electronic","value":"1468-3288"}],"subject":[],"published":{"date-parts":[[1985,10]]}}}