Abstract
A 56-year-old man with a history of chronic type C hepatitis admitted due to advanced gastric cancer with esophageal invasion underwent neoadjuvant chemotherapy, followed by total gastrectomy with lower esophagus resection. Postoperatively, refractory massive ascites not controllable with diuretics necessitated concentrated ascites reinfusion therapy starting on postoperative day (POD) 43. After 12 treatment cycles, ascites decreased somewhat but remained refractory, necessitating Denver peritoneovenous shunt surgery on POD 88. Abdominal distention ceased and laboratory data improved markedly. He was discharged on POD 98. Numerous interventions for medically refractory ascites, such as concentrated ascites reinfusion therapy, peritoneovenous shunt, and transjugular intrahepatic portosystemic shunt, have been applied to relieve the symptoms of massive ascites. Few reports have been made of refractory postoperative ascites successfully treated by peritoneovenous shunt. For patients with refractory postoperative ascites with a background of cirrhosis, however, the efficacy and risk of treatment must be thoroughly understood to select appropriate intervention, and timing.
