Peritoneovenous shunts for malignant ascites.

The intractable malignant ascites of 27 patients was treated by insertion of a peritoneovenous shunt. Eight had a Le Veen shunt, 17 a Denver shunt, one patient had a Denver shunt subsequently replaced by a Le Veen shunt and one a Denver shunt which was replaced by another Denver shunt. The operations were safely performed under local anesthesia. Shunt occlusion occurred in eight patients, in two of whom, however, the shunt was cleared with the flushchamber (Denver shunt) and by anticoagulant treatment (Le Veen shunt). In two further patients the shunts were replaced. All patients with a satisfactory functioning shunt had good palliation. Thanks to the shunts, 16 patients were able to leave hospital to spend their remaining time at home. Survival times were generally very short due to the patients' terminal malignancy, all patients dying within 4 months. In three patients there was a possible relationship between shunt placement and death. In conclusion, peritoneovenous shunting is indicated in selected patients with malignant ascites.