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PubMedDate not supplied

Diuretic-resistant ascites in cirrhosis. Mechanism and treatment.

Refractory ascites (or diuretic-resistant ascites), i.e. ascites that cannot be mobilized by medical treatment (low sodium diet and high doses of furosemide and spironolactone) is an infrequent phenomenon in cirrhosis. It usually occurs in patients with functional renal failure as a consequence of alteration in both pharmacokinetics and pharmacodynamics of diuretics. Peritoneovenous shunting, a procedure which improves systemic hemodynamics and renal function and suppresses the plasma levels of renin, aldosterone, norepinephrine and antidiuretic hormone in cirrhotics with ascites, has been proposed as the treatment of choice in patients with refractory ascites. Unfortunately it is associated to a high rate of severe complications and does not prolong the survival of these patients. Moreover, in approximately one third of the patients the shunt becomes occluded within the first year after operation. Recent studies have shown that repeated large volume paracentesis (4-64 per day until disappearance of ascites) or total paracentesis (complete mobilization of ascites in only one paracentesis session) associated to i.v. albumin infusion are an effective and safe therapy of ascites. At present, there is only one controlled trial comparing therapeutic paracentesis versus peritoneo-venous shunt in the management of patients with refractory ascites. In this study, there were no significant difference between both therapeutic groups with respect to survival. However, the incidence of readmission to hospital for the treatment of ascites was higher in the paracentesis group. Therefore, both procedures are valid therapeutic alternatives for that type of patients. Future studies are necessary to investigate if there are subsets of cirrhotics with refractory ascites in which one of these two types of treatment is especially indicated.

Ascites↗
PubMed1977

[Significance of suprapubic puncture of the bladder as a diagnostic method].

In 650 cases for the purpose of a methodical comparison was examined urine got by paracentesis of the bladder and midstream urine. The most important results were: 1. Urine got by paracentesis of the bladder was infected in 30.9%, midstream urine in 51.7%. 2. Further 39.4% of the samples of midstream urine were poor in germs; in 2.3% these findings corresponded to an infection. 3. Only 69.7% of the kinds of germs and 38.8% of the numbers of germs were identical. 4. 28.4% of the samples of midstream urine with a significant bacteriuria and 60.6% of those ones in the region of suspicion showed sterility in the corresponding urine got by paracentesis of the bladder. 5. On the other hand 30.8% of the infected urine got by paracentesis of the bladder did not reveal a significant bacteriuria in the midstream urine. These results confirm the relevance of the quickly performable and complicationless suprapubic paracentesis of the bladder as diagnostic method. It should more be taken into consideration in clinic and outpatient department.

Bacteriuria↗
PubMed1995

[Search for etiology in 110 cases of uveitis. Value of punctures of the aqueous humor and vitreous body].

PURPOSE: Evaluation of the frequency of each aetiology, comparison with recent and previous publications, focus on less classical pathologies, and interest of some complementary investigations. METHODS: Prospective study of one hundred and ten cases of uveitis, submitted to aetiological investigations, including, when feasible or necessary, an anterior chamber paracentesis and a vitreous paracentesis. RESULTS: An aetiology was identified in 65% of the cases. Toxoplasmosis still remained the most frequent diagnosis (one out of four), followed by viral infection (15%), especially herpes simplex (9%), a notion as yet not mentioned in large statistical surveys, including recent ones. Tuberculosis allergy and rhumatismal diseases (ankylosing spondylitis) represent the two other large groups (5% each). The rest is divided among the other classical causes. These results, particularly toxoplasmosis and viruses, are always based on biological criteria, on the Witmer-Desmonts ratio in aqueous humour, or even the same ratio in vitreous. CONCLUSION: This study confirms the predominant role of anterior chamber paracentesis, the only means of establishing a firm diagnosis for certain categories of uveitis (toxoplasmosis and viruses); it is difficult to conceive how such an investigation can be questioned, to the benefit of a purely biomicroscopic diagnosis, leading to blatant errors, as demonstrated by the results of anterior chamber paracentesis. This study also shows, due to this paracentesis, the increasing role of viruses in the aetiology of uveitis, emphasizing the risks taken when any uveitis is systematically submitted to corticotherapy.

Adolescent↗
PubMed2006

Modulation of ocular inflammatory responses by EP1 receptors in mice.

The purpose of the study was to investigate the role of EP1 receptors in intraocular inflammation and to determine possible interplay between EP1, EP2 and EP4 receptors. The eyes of separate groups of EP1 receptor knockout and wild type mice were: 1) treated topically with prostaglandin E2 (PGE2) or the EP2 receptor selective agonist, butaprost; 2) given intravitreal injection of LPS; or 3) paracentesis performed. Another group of knockout mice were pretreated topically with an EP4 receptor selective antagonist prior to paracentesis or LPS treatment. Results demonstrated a significant increase (50% or more) in the protein levels of aqueous humor of the EP1 knockout mice in response to PGE2, paracentesis or LPS. The leukocyte infiltration in the aqueous humor of the knockout mice was 47% higher when compared with that in the wild type controls in response to LPS injection. No significant change was observed in the protein levels in response to butaprost. Pretreating the knockout mice with an EP4 receptor antagonist prior to paracentesis and LPS treatment substantially reduced the aqueous humor protein levels. Also, the leukocyte count in the aqueous humor of the knockout mice in response to LPS was reduced 4 fold after pretreatment with EP4 receptor antagonist when compared with the findings in knockout mice receiving LPS only. We concluded that EP1 receptor has no modulatory effect on EP2 receptors but there is definitely cross-talk between EP1 and EP4 receptors.

Alprostadil↗
PubMed2002

Postparacentesis bilateral massive vulvar edema in a patient with severe ovarian hyperstimulation syndrome.

OBJECTIVE: To report a case of bilateral massive vulvar edema following lower abdominal paracentesis in a patient with ovarian hyperstimulation syndrome. DESIGN: Case report. SETTING: University teaching hospital. PATIENT(S): A 32-year-old woman with primary infertility. INTERVENTION(S): The patient underwent ovarian stimulation with leuprolide acetate, highly purified FSH, and hCG. Because of the development of severe ovarian hyperstimulation syndrome, bilateral paracentesis through the lower abdominal quadrants was performed. MAIN OUTCOME MEASURE(S): Treatment of ovarian hyperstimulation syndrome. RESULT(S): Development of bilateral massive vulvar edema 24 hours after lower abdominal paracentesis. CONCLUSION: This case report suggests that lower abdominal paracentesis could be the cause of vulvar edema development in ovarian hyperstimulation syndrome, probably due to a fistulous tract created between the peritoneal cavity and the subcutaneous tissues.

Adult↗
PubMed2000

A phase II trial of triamcinolone hexacetanide for symptomatic recurrent malignant ascites.

Ascites is a common complication of advanced cancer and frequently requires paracentesis to reduce symptoms of pain, anorexia, and dyspnea. For many patients repeat paracenteses are required at short intervals. We prospectively studied 15 patients with recurrent ascites of malignancy to determine if intraperitoneal triamcinolone hexacetonide, a slowly metabolized corticosteroid, produced objective and symptomatic responses. After biochemical, radiological, and symptom assessment and the establishment of the interval between paracenteses, patients underwent large-volume paracentesis followed by intraperitoneal triamcinolone hexacetonide 10 mg/kg. Patients were followed after treatment for assessment of symptoms and physical signs of ascites. Repeat paracentesis was performed when symptomatic ascites recurred. Symptomatic ascites recurred in 13 of 15 patients, but the interval between paracenteses was extended from 9.5 +/- 1.6 days to 17.5 days (P = 0.0086). Symptom questionnaire scores assessing well-being, nausea, abdominal pain, dyspnea, appetite, appearance, and change in abdominal size on a scale from 0 to 6 averaged 3.2 +/- 0.3 at entry and 2.5 +/- 0.2 at the 2-week assessment (P = 0.026). Self-assessed symptoms, feeling of well-being, abdominal distention, and physical appearance improved significantly. The mean serum cortisol decreased from baseline, suggesting that some systemic corticosteroid absorption occurred. Thirteen of 15 patients have died, with a median survival of 42 days. Potential adverse effects included 1 episode each of transient abdominal pain, bacterial peritonitis, and localized herpes zoster infection. In patients with ascites of malignancy, intraperitoneal triamcinolone hexacetonide appears to postpone the requirement for repeat paracentesis and improve symptoms of malignant ascites.

Adult↗
PubMed2003

Use of albumin in the management of patients with decompensated cirrhosis. An independent verdict.

The use of intravenous albumin in cirrhosis has been reactivated during the last two decades. During this period several investigations have shown that albumin (1) prevents circulatory dysfunction in patients with massive ascites treated by paracentesis, (2) prevents circulatory dysfunction and type-1 HRS and increases survival in patients with SBP, and (3) in association with vasoconstrictors normalizes circulatory function and serum creatinine and increases survival in patients with type-1 HRS. Indications 2 and 3 are clear. There is discussion, however, regarding indication number 1. Although no significant differences in survival have been observed in trials comparing patients treated by paracentesis with and without albumin, in none of these studies was survival an end-point of the trial. In contrast, there is evidence that paracentesis-induced circulatory dysfunction is associated with a bad outcome. In consequence, although further studies on this indication are clearly required, with the current data it is advisable to use albumin as a plasma expander in patients with massive ascites treated by paracentesis.

Albumins↗
PubMed2003

Reduction of abdominal pressure in patients with ascites reduces gastroesophageal reflux.

The effect of the reduction of intra-abdominal pressure on the lower esophageal sphincter pressure (LESP) and the 24-hour pH monitoring were studied in 16 patients with ascites before and after paracentesis. LESP did not change (P > 0.05) with the reduction of intra-abdominal pressure (before paracentesis: 17.48 mmHg and postparacentesis: 18.67 mmHg). The results were divided into two groups according to the achieved reduction in intra-abdominal pressure group A were those in who the reduction was greater than 70% and B consisted of those a reduction of less than 70%. LESP did not change even when results for each group were considered separately (P > 0.05): group A (before: 15.60 mmHg; after: 18.09 mmHg); group B (before: 23.09 mmHg; after: 20.40 mmHg). However the 24-h pH monitoring showed pathological reflux in patients with ascites that was reduced with the paracentesis (P < 0.05; total number of reflux episodes before paracentesis was 520.26, and after, 136.26). All pH-monitoring parameters were statistically different (P < 0.05) before and after the reduction of intra-abdominal pressure for group A but not for group B. LESP does not change significantly (P > 0.05) when the intra-abdominal pressure is significantly reduced (P < 0.05). Patients with ascites showed gastroesophageal reflux. Intra-abdominal pressure reduction greater than 70% lead to a significant reduction in gastroesophageal reflux.

Abdomen↗
PubMed2002

Laser flaremetric evaluation of experimentally induced blood-aqueous barrier disruption in cats.

OBJECTIVES: To determine whether aqueous humor flare, measured by use of laser flaremetry, was proportional to aqueous humor protein concentration and to use laser flaremetry to evaluate disruption of the blood-aqueous barrier (BAB) in cats. ANIMALS: 30 healthy adult cats. PROCEDURE: Laser flaremetry values for all eyes were compared with aqueous humor protein concentrations determined by use of a Coomassie blue microprotein assay. Laser flaremetry was then performed on both eyes before (0 hours) and 4, 8, and 26 hours after initiation of topical application of 2% pilocarpine (q 8 h) to 1 eye of 9 cats or paracentesis of the anterior chamber of 1 eye of 8 cats. Intraocular pressure and pupil size were also determined. Aqueous humor protein concentration was extrapolated from flare values by use of linear regression. RESULTS: There was a linear relationship between flare values and aqueous humor protein concentrations. Topical application of 2% pilocarpine and paracentesis of the anterior chamber caused a breakdown of the BAB that was detected by use of laser flaremetry. The highest mean flare readings after application of pilocarpine or paracentesis were 24.4 and 132.8 pc/ms, respectively, which corresponded to aqueous humor protein concentrations of 85.5 and 434.9 mg/dl, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Paracentesis of the anterior chamber resulted in a more severe breakdown of the BAB in cats than topical application of 2% pilocarpine. Laser flaremetry may be a useful clinical method to detect increases in aqueous flare and, hence, disruptions of the BAB in cats.

Animals↗
PubMedDate not supplied

Prognosis of patients with liver cirrhosis and spontaneous bacterial peritonitis.

BACKGROUND/AIMS: Patients with liver cirrhosis and ascites have a high risk of spontaneous bacterial peritonitis, but the prognostic impact of spontaneous bacterial peritonitis has not been well examined. METHODOLOGY: Patients with liver cirrhosis and ascites were included at the time of their first paracentesis during hospitalization in the Department of Hepatology, Aarhus University Hospital, Denmark, between September 1992 and September 2000. Cox regression was used to estimate the mortality of patients with spontaneous bacterial peritonitis (ascites leukocyte count > or = 250 per mm3) relative to controls without spontaneous bacterial peritonitis. Furthermore, we used Cox regression to estimate the change in mortality when controls developed spontaneous bacterial peritonitis during follow-up. RESULTS: Of 286 patients, 76 (27%) had spontaneous bacterial peritonitis at the first paracentesis. The mortality ratio of patients with spontaneous bacterial peritonitis relative to controls was 1.0 (95% confidence interval 0.7-1.5) after adjustment for age, gender, comorbidity, and alcohol abuse. Of the 210 controls, 42 (20%) were found to have spontaneous bacterial peritonitis at a later paracentesis. Their mortality rate more than doubled with the onset of spontaneous bacterial peritonitis. CONCLUSIONS: Spontaneous bacterial peritonitis at the first paracentesis did not affect the prognosis of patients with liver cirrhosis, whereas development of spontaneous bacterial peritonitis during follow-up doubled the mortality risk. This may be due to a longer diagnostic delay in those who developed spontaneous bacterial peritonitis during follow-up.

Adolescent↗
PubMedDate not supplied

Symptomatic ascites after discontinuation of continuous peritoneal dialysis.

OBJECTIVE: To analyze pathogenetic associations, clinical features, management, and outcome of ascites following discontinuation of continuous peritoneal dialysis (CPD). DESIGN: Retrospective analysis of symptomatic ascites, defined as ascites requiring at least one therapeutic paracentesis, developing in patients who discontinued CPD. SETTING: Dialysis unit of one tertiary care center. PARTICIPANTS: Twelve patients with 13 episodes of symptomatic ascites diagnosed soon after (a few days to 2 months) discontinuation of CPD. INTERVENTIONS: Diagnostic tests to characterize the pathogenesis of ascites; management of ascites by hemodialysis or CPD. MAIN OUTCOME MEASURES: Evolution of clinical features and nutritional parameters, survival. RESULTS: Ascites was infectious in 3 episodes (non-tuberculous mycobacterial peritonitis) and noninfectious in the remaining 10 episodes. Serum-to-ascites albumin concentration gradient (AG) was 6.3 +/- 1.5 g/L in infectious ascites and 17.3 +/- 2.7 g/L ( >11 g/L in every episode) in noninfectious ascites. Infectious ascites was managed with hemodialysis, prolonged courses of antimicrobial agents, and repeated paracentesis. Paracentesis ceased after 3-9 months. The patients were alive after 52 +/- 19 months. Seven episodes of noninfectious ascites were managed by hemodialysis and repeated paracentesis. Five patients died within 6 months from cardiac causes or sepsis. The remaining 2 patients died after 14 and 16 months from cardiac causes. Three episodes of noninfectious ascites in 2 patients were treated by restarting CPD within 2-5 months. Patients were alive at 16.9 +/- 13.2 months. They were asymptomatic and achieved fluid control. On the same CPD schedule, peritoneal clearances of urea and creatinine and normalized protein nitrogen appearance were unchanged between the initial and restarted CPD. Serum albumin was 33.3 +/- 2.5 g/L at the end of the first CPD period, 23.6 +/- 2.5 g/L soon after restarting CPD, and 31.3 +/- 5.5 g/L 4 months after restarting CPD. CONCLUSIONS: Noninfectious ascites after discontinuation of CPD is often characterized by an AG > 11 g/L, suggesting portal hypertension. Restarting CPD in noninfectious ascites may be associated with improvement in ascites symptomatology and nutritional parameters and with satisfactory survival.

Adult↗
PubMed1989

Treatment of ascites and renal failure in cirrhosis.

Ascites is a frequent complication in patients with liver cirrhosis. The accumulation of fluid in the abdominal cavity is associated with disturbances of systemic and splanchnic haemodynamics and of kidney function, which contribute to the poor prognosis of these patients. Classically, the treatment of ascites in patients with cirrhosis has been based on the combination of a sodium-restricted diet and the administration of diuretics. However, this treatment is not entirely satisfactory, since it is associated with a relatively high incidence of side-effects, and about 20% of patients hospitalized for the treatment of an episode of ascites do not respond to such therapy. In the last two decades, alternative therapies to diuretics have been introduced. PVS is an effective method of treating ascites. The high incidence of complications observed in early studies may be reduced by adequate perioperative management and careful selection of patients. The role of the PVS in the treatment of cirrhotics with ascites, however, still remains to be established. Recently, paracentesis has emerged as an alternative method of treating ascites in patients with cirrhosis. Several studies have shown that therapeutic paracentesis plus i.v. albumin infusion is more effective than conventional diuretic therapy and is associated with a lower incidence of complications. It has also been demonstrated that therapeutic paracentesis without the i.v. administration of albumin is associated with a marked increase in plasma renin activity, suggesting an impairment of effective blood volume, and with the development of hyponatraemia and/or renal failure in 20% of cases. Therefore, the i.v. administration of albumin is an essential measure in preventing the impairment of systemic haemodynamics and renal function that frequently follows the mobilization of ascites by paracentesis.

Ascites↗
PubMed1998

Subumbilical midline vascularity of the abdominal wall in portal hypertension observed at laparoscopy.

BACKGROUND: Large volume paracentesis is a common treatment of ascites. Injury to abdominal wall collateral veins during this procedure can lead to hemoperitoneum. Because of this concern, the midline below the umbilicus is often recommended as a site for paracentesis because of its presumed avascularity. METHODS: We examined the subumbilical peritoneal surface in 20 consecutive patients with liver disease undergoing diagnostic laparoscopy. This area was visualized by table tilting and confirmed by external finger compression. Nineteen patients had cirrhosis of various etiologies, and one had advanced fibrosis with evidence of portal hypertension. RESULTS: In these 20 patients, only 7 had avascular midlines below the umbilicus. Seven had small but definite veins running along the path of the urachus (median umbilical fold), and 6 had more prominent veins in this region. The internal landmarks in this region (median and medial folds) were frequently asymmetric with regard to the external appearance of the midline. CONCLUSION: The subumbilical midline in patients with portal hypertension is commonly vascular. When using this site for paracentesis, care should be exercised to identify venous structures with the narrow-gauge needle used to inject local anesthetic agent before placement of larger paracentesis needles.

Abdominal Muscles↗
PubMed1998

A survey of practice in management of malignant ascites.

The purpose of this study was to determine physicians' attitudes toward and preferences for palliative management of malignant ascites. A random sample of eighty physicians practicing in Canada was selected from the memberships of the Canadian Association of Medical Oncologists, the Canadian Association of Gastroenterology, the Canadian Society of Palliative Care Physicians, and the Society of Gynecologic Oncologists of Canada. Physicians were questioned on their use of different modalities in management of malignant ascites, and preferences based on attitudes toward efficacy of various treatments. Eighty surveys were mailed, with a second mailing, followed by telephone contact. The response rate was 76% (59/78), with two potential respondents deemed ineligible. Among the 44 physicians who treat malignant ascites, paracentesis is employed by 43 (98%), and felt to be effective by 39 (89%). Diuretics are used by 61% (27/44), although fewer feel diuretics are effective management (20/44, 45%). Peritoneovenous shunts, dietary measures, and other modalities are used less frequently than either paracentesis or diuretics. The most commonly used means of managing malignant ascites is paracentesis, which is also felt to be the most effective by the group surveyed. After paracentesis, diuretics and peritoneovenous shunting are used most frequently, but there is no apparent consensus as to their effectiveness. Managing malignant ascites remains problematic, and we propose further study of management strategies to clarify the role of various treatments.

Adult↗
PubMed1981

The effect of ascitic fluid hydrostatic pressure on albumin extravasation rate in patients with cirrhosis of the liver.

Overall transvascular escape rate of albumin [TERalb, i.e. the fraction of intravascular mass of albumin (IVMalb) passing to the extravascular space per unit time] was determined from the disappearance of i.v. injected radioiodinated serum albumin. Patients with tense ascites due to liver cirrhosis and pigs with posthepatic portal hypertension and intraperitoneally instilled fluid were studied before and after abdominal paracentesis in order to evaluate the effect of ascitic fluid hydrostatic pressure on the transvascular escape rate of albumin. TERalb of the ascitic patients (n = 6) were on average 7.8% IVMalb.h-1, which is somewhat higher but not significantly above normal (mean 5.6% IVMalb.h-1). After paracentesis and removal of the ascitic fluid, TERalb rose significantly to an average of 11.9% IVMalb.h-1 (P less than 0.05). The fraction of IVMalb passing into the peritoneal cavity was on average 0.21 and 0.38% IVMalb.h-1 before and after paracentesis, respectively (n = 4). In ascitic, posthepatic portal-hypertensive pigs (n = 6), TERalb averaged 15.1% IVMalb.h-1, a value not being significantly different from non-ascitic, normotensive controls (mean 16.1% IVMalb.h-1). After paracentesis, TERalb rose significantly to an average of 24.3% IVMalb.h-1. The increased albumin extravasation rate after removal of ascites is best explained by an increased sinusoidal-tissue pressure difference caused by a decreased hydrostatic fluid pressure in the liver interstitium (portal and subcapsular spaces) due to the hydrostatic effect of the removed ascitic fluid.

Abdomen↗
PubMed1984

Effect of lysine-acetylsalicylate and phenylbutazone premedication on the protein content of secondary aqueous humour in the dog.

Inhibitory effects of the anti-inflammatory agents lysine-acetylsalicylate (LAS) and phenylbutazone (PBZ) on the breakdown of the blood-aqueous barrier by paracentesis were studied in canine eyes using protein determination of ocular fluid. In the untreated eyes the aqueous protein value was raised from 0.29 +/- 0.17 (mean +/- SD) g litre-1 at the initial paracentesis to 14.47 +/- 4.10 g litre-1 at the second paracentesis. Pretreatment with LAS or PBZ had no significant effect on the protein concentration of the primary aqueous humour. However the secondary aqueous protein concentration was only 10.05 +/- 7.00 g litre-1 with LAS and 5.80 +/- 3.83 g litre-1 with PBZ. With both drugs the maximum inhibitory effect was observed on the gammaglobulins and albumin. These results suggest that prostaglandins may be involved in the response of the canine eye to paracentesis and that premedication with LAS or PBZ may be of value in reducing postoperative ocular inflammation.

Analgesics↗
PubMed1996

Comparative efficacy of topically applied flurbiprofen, diclofenac, tolmetin, and suprofen for the treatment of experimentally induced blood-aqueous barrier disruption in dogs.

OBJECTIVE: To compare the relative efficacies of 4 topical nonsteroidal anti-inflammatory drugs at preventing blood-aqueous barrier (BAB) disruption in dogs. DESIGN: 1 eye of each dog was treated with 1% suspensions of diclofenac, flurbiprofen, suprofen, or tolmetin, or with control solution. After 4 applications of eyedrops at 10-minute intervals, BAB disruption was induced in the treated eye by anterior chamber paracentesis. The severity of BAB disruption was measured by anterior chamber fluorophotometry. ANIMALS: 40 ocular-normal dogs. PROCEDURE: After pretreatment with eyedrops, rapid 100-microliters nonleaking anterior chamber paracentesis was performed in 1 eye of each dog to induce BAB disruption. 1 day after paracentesis, 1 ml of 10% fluorescein sodium was injected i.v.. The amount of fluorescein entering the anterior chamber of each eye was measured 30 to 60 minutes later by use of a computerized scanning fluorophotometer. The degree of BAB disruption was determined by comparing the amount of fluorescein entering the aqueous humor of the paracentesed eye with that of the nonparacentesed eye. RESULTS: At postparacentesis day 1, the order of statistically significant BAB-stabilizing efficacy among groups was: diclofenac > flurbiprofen > suprofen > tolmetin = control solution. CONCLUSIONS: Topically applied 1% suspensions of diclofenac, flurbiprofen, and suprofen are effective at preventing BAB disruption after paracentesis in dogs, indicating their potential usefulness for treatment of prostaglandin-mediated ocular disease. 1% tolmetin is no more effective than control solution.

Animals↗
PubMed2000

Indwelling catheters for the management of malignant ascites.

Paracentesis is widely employed for palliation of symptomatic malignant ascites. In some patients, there is rapid re-accumulation of fluid necessitating frequent repeat procedures. Indwelling peritoneal drainage catheters can provide more durable symptom relief, avoiding the hazards and disadvantages of multiple repeat procedures. The goal of our study was to evaluate the technical success, complications and outcome associated with the use of these drainage catheters. We carried out a retrospective review of all patients who had indwelling catheters inserted for the management of symptomatic malignant ascites over a 4-year period. A total of 45 catheters were inserted in 38 patients. Insertion was technically successful in all patients, with immediate symptomatic relief. However, 2 cases of fatal hypotension were encountered in the first 24 h after catheter insertion (acute catheter-related mortality rate of 4.4%). These were attributed to rapid drainage of peritoneal fluid, although gastrointestinal tract bleeding was contributory in the second patient. Eight patients were lost to follow-up. Of the remaining 30, 13 (35.1%) patients developed catheter-related sepsis. The rate of infection was 1.6 episodes per 100 catheter-days. Thirteen tubes were removed prematurely, 6 (16.2%) due to sepsis, 5 (13.5%) because of tube blockage and 2 (5.4%) because of loculated ascites. The median length of time for which catheters were functional was 37 days (95% CI 14.1-59.6), with an average daily drainage of 539.5 ml (range 18-4000 ml). In conclusion, indwelling peritoneal drainage catheters provide a useful alternative to paracentesis in the management of symptomatic malignant ascites. Although it avoids the need for repeated paracentesis, it is not without risks. We discuss and propose some precautions to be observed in the use of these catheters.

Adult↗