PERITONEOVENOUS SHUNT WITH FEMORAL VEIN FOR INTRACTABLE ASCITES-SOMETHING UNIQUE

Intractable ascites is a very common symptomatology which our internists come across in their daily practice.Its a difficult situation to deal with more so for the fact that the general health of the patient is not great and the renal parameters are also deranged in most of the cases along with the ongoing hepatic problem(Hepatorenal syndrome).These patients frequent their doctors for ascitic tap or else for hepatic encephalopathy and related issues.Surgeons have tried various treatment modalities including venovenous shunts with variable results.These procedures have their own benefits and pitfalls.
In older times LeVeen shunt was used aggressively for intractable ascites but has been replaced by the Denever shunt .Using foreign material has always been dicey as the chance of infection is relatively high more so in these immunocompromised patients with the shunt placed subcutaneously.This issue has been of perennial concern for the attending surgeons and has led to the birth of biological grafts wherein saphenous vein is attached to the rent created in peritoneum for ascitic fluid drainage.Few small series of this mode of treatment modality are available on the net for one and all to see.

We report to you a unique case of intratractable ascites in a 65 years old male who was not a case for TIPS or other traditional VenoVenous shunts for multiple reasons and was referred to me for a possible peritoneovenous shunt.I went through the literature available on net and realized that the probable cause for the occlusion of the saphenous shunt was the small caliber of the vein.So we tried something unique in this case which probably has never been attempted anywhere before in a case like this.We harvested the SUPERFICIAL FEMORAL VEIN from the thigh and anastomosed the proximal end of it to the rent in the peritoneum for ascitic fluid drainage.We found the caliber of the saphenous vein to be small intraoperatively though we never intended to use it otherwise also.

No doubt this is a palliative surgery intended to give better quality of life but till it serves its purpose its worth it.

A special thanks to Dr.Bhanu for having faith in me and referring the case to me for surgery and Subedar(retd.)R.S Randhawa for assisting me in the theatre.