Treatment:
1-Large-volume paracentesis is now recognized as a safe and effective therapy for the treatment of refractory ascites. Removal of ascitic fluid volume of up to 5 L without the simultaneous infusion of plasma expanders such as concentrated albumin is safe in non-edematous patients. Larger volumes can be removed in edematous patients. However, repeated paracenteses may not be practical for all patients with refractory ascites, and a peritoneovenous( LeVeen Shunt ) should be considered in selected patients with good liver reserve. It may be dramatically effective in resolving the ascites, but in patients with decompensated liver disease it is followed by higher morbidity and mortality. Previous abdominal surgery, spontaneous bacterial peritonitis and large varices are relative contraindications to the procedure.
Early complications: include pulmonary edema and disseminated intravascular coagulopathy.
Late complications: include thrombosis of the superior vena cava, infection and blockage or dislodgement of the shunt, all of which require its immediate removal.In suitable patients, the LeVeen shunt, in addition to improved management of ascites, can significantly enhance well-being and nutritional status.

2-Transjugular intrahepatic portal-systemic shunt (TIPS)  has been shown to be an effective means of managing refractory ascites. This method involves creating a communication between a branch of the hepatic vein and a branch of the portal vein held open by a metal stent.

3-Liver transplantation should always be considered as a treatment option.

Back