Case Report
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World J Gastrointest Surg. Jan 27, 2011; 3(1): 16-20
Published online Jan 27, 2011. doi: 10.4240/wjgs.v3.i1.16
Peritoneovenous shunt for intractable ascites due to hepatic lymphorrhea after hepatectomy
Yoshihiro Inoue, Michihiro Hayashi, Fumitoshi Hirokawa, Atsushi Takeshita, Nobuhiko Tanigawa
Yoshihiro Inoue, Michihiro Hayashi, Fumitoshi Hirokawa, Nobuhiko Tanigawa, Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
Atsushi Takeshita, Department of Pathology, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
Author contributions: Inoue Y conceived the study concept and design, was involved with patient care and drafted the manuscript and literature review; Hayashi M, Hirokawa F, Takeshita A and Tanigawa N were involved with formation of the study concept and design, patient care and drafting of the manuscript and literature review; all authors have read and approved the final version of the manuscript.
Correspondence to: Yoshihiro Inoue, MD, Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan. sur129@poh.osaka-med.ac.jp
Telephone: +81-72-6831221 Fax: +81-72-6852057
Received: May 12, 2010
Revised: September 19, 2010
Accepted: September 26, 2010
Published online: January 27, 2011
Abstract

A peritoneovenous shunt has become one of the most efficient procedures for intractable ascites due to liver cirrhosis. A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented. A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection. After hepatectomy, a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy, including numerous infusions of albumin and plasma protein fraction and administration of diuretics. Since the patient’s general condition deteriorated, based on the diagnosis of intractable hepatic lymphorrhea, a subcutaneous peritoneovenous shunt was inserted. The patient’s postoperative course was uneventful and the ascites decreased rapidly, with serum total protein and albumin levels and hepatic function improving accordingly. For intractable ascites due to hepatic lymphorrhea after hepatectomy, we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.

Keywords: Peritoneovenous shunt; Surgical procedure; Intractable ascites; Hepatic lymphorrhea; Hepatocellular carcinoma