Abstract
Intravenous reinjection of ascitic fluid after its filtration and concentration was performed to prevent pulmonary edema in patients with intractable ascites resistant to medical therapy. After reduction of the ascitic fluid volume, a peritoneo-caval shunt was created, using a LeVeen's pump, such that the ascitic volume could be semipermanently reduced.
Six patients including 4 males and 2 females, whose ages ranging from 42 to 65 years old (mean age: 55.3 years old), were evaluated with regard to the effects of this mode of combination therapy. Ascites resulted from chronic renal failure in 2 patients, from liver cirrhosis in 2, from gastric cancer in 1, and from uterine cancer in 1.
The ascites was treated by a Plascit-01 system (Asahi Medical Co.). Filtration was done using an AHF-MA filtration system and subsequent concentration was achieved with an AHF-UN concentration system. Two to 4 liters of the recovered ascites were filtered and concentrated to 100-200 mililiters, and intravenously reinjected into the patients in 4-7 divided doses (mean number of doses: 4.8). Subsequently, an ascites shunt was created between the peritoneal cavity and the superior vena cava.
Of the 6 patients evaluated, 5 died. Survival was prolonged from 1 to 3.5 years in our patients (mean duration of prolonged survival: 2.3 years) with the use of these combined methods. Symptoms were also ameliorated during the period of prolonged survival. The one remaining patient is presently on hemodialytic therapy and in stable clinical condition 4.2 years after undergoing combined treatment. No complications were noted in our patients while they were being treated with either the intravenous reinjection of ascitic fluid or the shunt creation procedure.
Our findings showed that the combination of intravenous reinjection after filtration and concentration of ascites and creation of a peritoneo-caval shunt is more effective and safer than either one of the 2 forms of treatment used alone for treatment of patients with intractable ascites.
