Abstract

INTRODUCTION
Intractable ascites in neonates has a varied etiology; and often, the cause is idiopathic. The management usually consists of observation, diuretics, paracentesis, albumin replacements, and self correction. However, in some cases, the above treatment remains unsuccessful.
RESULTS
We present 2 cases of intractable ascites causing metabolic abnormalities, severe protein and immunoglobulin loss, and respiratory compromise. Although the use of peritoneovenous shunts for intractable ascites has been reported previously, our cases differ in both technique and patient size. Our first patient is an ex-28-week premature, 1.4-kg infant with intractable ascites for which a peritoneal drain was initially placed. After 3 weeks and putting out nearly 300 mL of ascitic fluid daily, we placed a peritoneal venous shunt attached to a Medtronic pump. A 6.6F Broviac was placed through the Internal Jugular. The Medtronic pump was placed subcutaneously on the right chest. The pump was compressed 5 to 10 times every 8 hours, keeping fluid actively being infused from the belly to the vascular system. The second patient was 5 months old, 2.8 kg, with a course complicated by necrotizing enterocolitis, prolonged total parenteral nutrition, and progressive liver failure and underwent the same procedure. Both patients had dramatic responses to the shunting postoperatively, with clinical, radiographic, and laboratory evidence of resolution of the ascites. The first patient had the shunt removed at 6 months of age and continues to do well, whereas our second patient had no recurrence of the ascites, but died about 1 year later from cardiopulmonary complications.
CONCLUSION
These 2 cases demonstrate that peritoneovenous shunting, with the assistance of a Medtronic pump, is an effective treatment of intractable neonatal ascites and should be considered early in the course before complications develop.

Links

Publisher Full Text

Authors

Herman R, Kunisaki S, Molitor M, Gadepalli S, Hirschl R, Geiger J

Institution

Division of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan Ann Arbor, MI 48104, USA. richerma@med.umich.edu

Source

Journal of pediatric surgery 46:8 2011 Aug pg 1651-4

MeSH

Ascites
Humans
Infant
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases
Male
Peritoneovenous Shunt

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

21843738