Management of malignant ascites with peritoneovenous shunting.

The onset of intractable ascites secondary to malignant disease is a harbinger of a short life span (less than 8 weeks) in most patients. Repeated paracentesis is a preferable form of management unless a longer life span is anticipated. In patients with ovarian or breast carcinoma, peritoneovenous shunting is an effective means of controlling malignant ascites. In addition, long-term symptomatic relief can be achieved for the balance of the patient's life. Postoperative coagulation defects are minimal if most of the ascites is removed at the time of shunt placement. Circulating fibrin split products universally appear postoperatively in the peripheral circulation of patients with patent shunts. Pulmonary metastasis is not a clinically significant problem secondary to placement of the peritoneovenous shunt for malignant ascites.