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Treatment of Intractable Ascites by Peritoneal A trial Shunt

Gordon L. Hyde, MD; Franklin B. Moosnick, MD
JAMA. 1967;201(4):264-266. doi:10.1001/jama.1967.03130040060019.
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THE DEVELOPMENT of intractability in controlling ascites in patients with cirrhosis of the liver is often an ominous sign in the terminal phase of this disease. Despite programs for mobilizing ascitic fluid by using newer diuretics, aldosterone antagonists, and steroids, there still remains a group of patients resistant to all forms of medical therapy. Removal of ascitic fluid by repeated paracenteses gives only short-term relief at best, while compounding protein and electrolyte wasting in patients who can ill afford it.

Many methods have been devised for the treatment of intractable ascites, but all have certain basic shortcomings which have limited their usefulness. Recently, the demonstration that ascitic fluid can be given intravenously suscessfully, with improvement to the patient without side effects or difficulties, has reawakened interest in this approach to treatment.1,2 However, most techniques for reinfusion of ascitic fluid, at best, are bulky and awkward. Smith (1962) reported the


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