DESPITE stringent medical therapy, including salt and water restriction and the use of diuretics, salt-poor albumin, and corticosteroids, ascites refractory to treatment develops in an occasional patient with cirrhosis. Because the development of ascites is primarily a mechanical problem, with increased hepatic-outflow vascular resistance,1 decreased transport capacity for liver lymph, and an increased permeability of hepatic sinusoids, procedures to return ascitic fluid back into the circulatory system have been resorted to in these cases.2 Recent success with the placement of a peritoneovenous shunt for ascites as described by Le Veen et al3 led to the use of this shunt in the patient reported here. Studies of aldosterone secretion, not previously described with this form of treatment, were performed on this patient and indicate that this shunt markedly reduces the usual secondary hyperaldosteronism that accompanies massive ascites.
Report of a Case
A 65-year-old man with biopsy-proved Laënnec cirrhosis