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Refractory ascites

Florence Wong, Peter Jepsen, Hugh Watson, Hendrik Vilstrup
BACKGROUND & AIMS: Acute episodes of renal dysfunction or acute kidney injury (AKI) in cirrhotic patients with ascites are mostly precipitated by an acute event. The prevalence of un-precipitated AKI in stable ascitic cirrhotic patients is unknown. The aims of this study were to determine i) the prevalence of un-precipitated AKI in stable cirrhotics with ascites, and ii) any predictive factors for its development. METHODS: 1115 stable cirrhotic patients with mild liver and renal dysfunction but varying degrees of ascites severity from 3 previous satavaptan versus placebo randomized controlled trials (group A: ascites requiring diuretics but not paracentesis; Group B: ascites requiring frequent paracentesis; Group C: refractory ascites) were included...
March 13, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
Rajiv N Srinivasa, Jeffrey Forris Beecham Chick, Joseph J Gemmete, Anthony N Hage, Ravi N Srinivasa
INTRODUCTION: To report the technical and clinical success of performing minimally invasive endolymphatic embolization in neonates presenting with a chylothorax or chylous ascites. MATERIALS AND METHODS: 3 neonates, 2 males and 1 female, with a mean age of 28 days (range: 19-39 days) presented with a chylothorax (2) or chylous ascites (1) which was refractory to conservative management. All 3 patients (1 previously reported) underwent intranodal lymphangiography followed by thoracic duct embolization with 1 patient undergoing additional sclerosis of the retroperitoneal abdominal lymphatics...
March 7, 2018: Annals of Vascular Surgery
Boya Abudu, David P Duncan, Elliot Deyoung, Gerant Rivera-Sanfeliz
Paracentesis is a common procedure used in the diagnostic evaluation of peritoneal fluid as well as the therapeutic removal of high-volume ascites. Although generally regarded as a safe procedure, complications may arise from arterial injury, including hematomas and pseudoaneurysms. Transcatheter embolization and surgery are first-line interventions for injuries refractory to conservative management. We present a case where a patient failed conventional therapies for hemoperitoneum following a paracentesis which resolved after thrombin injection into the subcutaneous tissues, a novel use for thrombin...
February 2018: Radiology Case Reports
Bao Z Yao, Liang Li, Ming Jiang, Jie Wang, Jun Zhang
RATIONALE: Gallstone disease is commonly worldwide and safely treated by laparoscopic cholecystectomy. Chylous ascites is a rare but serious complication of many abdominal operations. PATIENT CONCERNS: We present a rare case of refractory chyle leakage post-LC for acute cholecystitis that is successfully treated in a 40-year-old man, and review current literature on the prevalence, diagnosis, and management of this complication. DIAGNOSES: Refractory chyle leakage post-LC, a rare but serious complication after laparoscopic cholecystectomy...
January 2018: Medicine (Baltimore)
Jonel Trebicka
Does transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the effective blood volume. In cases of acute variceal hemorrhage and with a high risk of treatment failure, defined as either hepatic venous pressure gradient higher than 20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than 14 points, early or preemptive placement of TIPS (within 72 hours) improves survival. Also, in suitable patients with intractable or refractory ascites, TIPS improves survival if placed early in the course of treatment...
February 2018: Seminars in Liver Disease
Maria Stepanova, Fatema Nader, Christophe Bureau, Danielle Adebayo, Laure Elkrief, Dominique Valla, Markus Peck-Radosavljevic, Anne McCune, Victor Vargas, Macarena Simon-Talero, Juan Cordoba, Paolo Angeli, Silvia Rossi, Stewart MacDonald, Jeroen Capel, Rajiv Jalan, Zobair M Younossi
BACKGROUND: Refractory ascites (RA) is a complication of cirrhosis which is treated with large volume paracentesis (LVP) as the standard of care. Alfapump® system is a fully implantable pump system which reduces the need for LVP. The aim was to assess health-related quality of life (HRQL) in patients treated with alfapump® versus LVP. METHODS: The data were collected in a multicenter open-label randomized controlled trial ( #NCT01528410). Subjects with cirrhosis Child-Pugh class B or C accompanied by RA were randomized to receive alfapump® or LVP...
February 19, 2018: Quality of Life Research
Nishtha Sanjay Nagral, Vijay Waman Dhakre, Nirzar Parikh, Shaji Marar
A 33-year-old man of a Middle Eastern origin presented to us with abdominal pain and distension secondary to refractory ascites of 1-month duration. The patient had a history of taking oral retinoic acid 25 mg for 4 months for mycosis fungoides. Investigations revealed thrombosis of hepatic veins with extensive thrombosis of the porto-mesenteric axis. A combination of transjugular intrahepatic portosystemic shunt, balloon angioplasty and thrombolysis with recombinant tissue plasminogen activator was successfully used to treat his condition...
February 5, 2018: BMJ Case Reports
Junxiu Liu, Huanxiao Zhang, Qiqiao Du, Shuzhong Yao
A 23-year-old female patient with refractory chylous ascites was successfully treated with laparoscopic ligation of the ruptured lymphatic vessel. The young patient developed abdominal distention after right side pelvic lymph node dissection for dysgerminoma of the right ovary. Conservative managements failed to control the symptoms. Laparoscopic surgery was carried out after oral administration of peanut oil, revealing the presence of a whitish fluid in the abdominal cavity. The responsible lesion of the chylous ascites was detected in the right obturator fossa and ligated with HEM-O-LOK...
February 7, 2018: Journal of Minimally Invasive Gynecology
Gonçalo Nunes, Cristina Fonseca, Rita Barosa, Marta Patita, André Gomes, Júlio Botas, Hélder Coelho, Maria José Brito, Jorge Fonseca
The authors describe a 47-year-old man infected with human immunodeficiency virus admitted for ascites and weight loss. Ascitic fluid analysis revealed chylous ascites (triglycerides 444 mg/dl) with negative microbiological tests. Neoplasia, cardiac disease and liver cirrhosis were excluded after an extensive diagnostic workout. Exploratory laparotomy with tissue sampling did not clarify ascites etiology. During hospital admission, patient status gradually deteriorated, severe malnutrition developed and ascites became refractory to diuretics...
February 9, 2018: Clinical Journal of Gastroenterology
Oana Anisa Nutu, Iago Justo Alonso, Alberto Alejandro Marcacuzco Quinto, Jorge Calvo Pulido, Luis Carlos Jiménez Romero
Refractory ascites is an uncommon complication that may develop postoperatively after liver transplantation. The diagnosis and treatment of this condition is a real challenge. We report two cases of patients who underwent a transplant due to cryptogenic cirrhosis and developed refractory ascites during the immediate postoperative period. This is a serious complication associated with decreased survival by up to one year and a reduced quality of life. After ruling out the main causes of ascites, a portal hyperflow was a potential etiology...
February 7, 2018: Revista Española de Enfermedades Digestivas
Agnete Nordheim Riedel, Nina Kimer, Lise Hobolth, Lise Lotte Gluud
OBJECTIVE: To evaluate the safety of PleurX in cirrhotic patients with refractory ascites. METHODS: We prospectively registered patients who received a PleurX catheter cirrhosis-associated refractory ascites at our department from July 2015 to November 2016. Our control group consisted of matched cirrhotic patients with refractory ascites treated with large volume paracentesis (LVP) and patients with malignant ascites treated with PleurX during the same period. RESULTS: We included 25 patients with cirrhosis-related ascites (7 in PleurX group) and 17 with malignant ascites (14 in PleurX group)...
February 7, 2018: Scandinavian Journal of Gastroenterology
Jeffrey Wang, Shahida Khan, Paige Wyer, Jessica Vanderwilp, Justin Reynolds, Bruce Bethancourt, Ken S Ota
BACKGROUND: Patients with ascites suffer from distressing symptoms and are at high risk for readmission after hospitalization. Timely paracentesis is an important palliative tool in managing this vulnerable population. At our institution, we have developed a multidisciplinary transitional care program for patients discharged from the hospital with a wide range of complex conditions including refractory ascites. METHODS: We present a case series of 10 patients with symptomatic ascites who were enrolled in our transitional care program and treated with ultrasound-guided therapeutic paracentesis in our clinic...
January 1, 2018: American Journal of Hospice & Palliative Care
Christophe Bureau, Danielle Adebayo, Mael Chalret de Rieu, Laure Elkrief, Dominique Valla, Markus Peck-Radosavljevic, Anne McCune, Reyad Abbadi, Victor Vargas, Macarena Simon-Talero, Juan Cordoba, Paolo Angeli, Silvia Rosi, Stewart MacDonald, Massimo Malago, Maria Stepanova, Zobair M Younossi, Claudia Trepte, Randall Watson, Oleg Borisenko, Sun Sun, Neil Inhaber, Rajiv Jalan
No abstract text is available yet for this article.
January 29, 2018: Journal of Hepatology
Katsuya Ohta, Masakazu Ikenaga, Masami Ueda, Ryuji Iwaki, Tae Kinoshita, Kyoko Mishima, Kiyo Shindo, Yoshinao Chinen, Hiroaki Itakura, Takatoshi Takayama, Yujiro Tsuda, Shinsuke Nakashima, Shinichi Adachi, Shunji Endo, Terumasa Yamada
Malignant intractable ascites worsens not only patient symptoms but also their daily activities. It often leads to a patient discontinuing or postponing chemotherapy. In the present study, we introduced cell-free and concentrated ascites reinfusion therapy(CART)for malignant intractable ascites from colorectal cancer. Six patients underwent 12 CART treatments using AHF-WMO as the ascites filterand AHF-UP as the concentrator(Asahi Kasei Medical Co., Ltd.)from January 2014 to January 2017. The patients included 2 men and 4 women aged 67-89 years...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
N Pfisterer, C Dexheimer, E-M Fuchs, T Bucsics, P Schwabl, M Mandorfer, I Gessl, L Sandrieser, L Baumann, F Riedl, B Scheiner, T Pachofszky, W Dolak, C Schrutka-Kölbl, A Ferlitsch, M Schöniger-Hekele, M Peck-Radosavljevic, M Trauner, C Madl, T Reiberger
BACKGROUND: Endoscopic band ligation (EBL) is used for primary (PP) and secondary prophylaxis (SP) of variceal bleeding. Current guidelines recommend combined use of non-selective beta-blockers (NSBBs) and EBL for SP, while in PP either NSBB or EBL should be used. AIM: To assess (re-)bleeding rates and mortality in cirrhotic patients receiving EBL for PP or SP for variceal bleeding. METHODS: (Re-)bleeding rates and mortality were retrospectively assessed with and without concomitant NSBB therapy after first EBL in PP and SP...
February 1, 2018: Alimentary Pharmacology & Therapeutics
Valentina Schembri, Christophe Cassinotto, Fabrizio Panaro, Julien Delicque, Marie-Ange Pierredon, Lauranne Piron, Astrid Herrero, Laure Escal, José Ursic-Bedoya, Boris Guiu
PURPOSE: The hepatic vein access during transjugular intrahepatic portosystemic shunt (TIPS) can be challenging in liver transplant recipient patients, especially when piggyback anastomosis was performed. We described a modified technique and reviewed the clinical outcomes of TIPS in transplanted patients. MATERIALS AND METHODS: From 2015 to 2016, 8 patients with history of liver transplantation using a three-hepatic vein piggyback technique for venous anastomosis underwent a TIPS in our institution...
January 31, 2018: Cardiovascular and Interventional Radiology
Jennifer A Knight, Scott M Thompson, Chad J Fleming, Emily C Bendel, Melissa J Neisen, Newton B Neidert, Andrew H Stockland, Haraldur Bjarnason, David A Woodrum
PURPOSE: To determine the safety and effectiveness of tunneled peritoneal catheters in the management of refractory malignant and non-malignant ascites. MATERIALS AND METHODS: An IRB-approved retrospective review was undertaken of patients who underwent ultrasound and fluoroscopy-guided tunneled peritoneal catheter placement for management of refractory malignant or non-malignant ascites between January 1, 2009, and March 14, 2014. RESULTS: A total of 137 patients (76 M/61 F, mean age 62...
January 17, 2018: Cardiovascular and Interventional Radiology
Laura Turco, Guadalupe Garcia-Tsao, Ilenia Magnani, Marcello Bianchini, Martina Costetti, Cristian Caporali, Stefano Colopi, Emilio Simonini, Nicola De Maria, Federico Banchelli, Rosario Rossi, Erica Villa, Filippo Schepis
BACKGROUND AND AIMS: The main stages of cirrhosis (compensated and decompensated) have been substaged based on clinical, endoscopic, and portal pressure (determined by the hepatic venous pressure gradient, HVPG) features. Vasodilatation leading to a hyperdynamic circulatory state is central in the development of a late decompensated stage with inflammation being currently considered a key driver. We aimed to assess hepatic/systemic hemodynamics and inflammation (by C reactive protein, CRP) among the different substages of cirrhosis and to investigate their interrelationship and prognostic relevance...
January 10, 2018: Journal of Hepatology
Hanako Tsurumi, Yoshihide Fujigaki, Tadashi Yamamoto, Risa Iino, Kei Taniguchi, Michito Nagura, Shigeyuki Arai, Yoshifuru Tamura, Tatsuru Ota, Shigeru Shibata, Fukuo Kondo, Nozomu Kurose, Yasufumi Masaki, Shunya Uchida
Thrombocytopenia, ascites, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome is a newly recognized but rare disease, and its treatment has not yet been established. We reported a 50-year-old woman with TAFRO syndrome diagnosed 2 years after the initial symptoms of a fever, fatigue, epigastric pain, edema, ascites, lymphadenopathy, thrombocytopenia and renal insufficiency. The patient showed refractory ascites and required hemodialysis under corticosteroid mono-therapy for suspected immune-mediated disease but was successfully treated with additive rituximab, resulting in improvement in her laboratory data, the withdrawal of hemodialysis and the disappearance of ascites...
January 11, 2018: Internal Medicine
Hayato Yamaguchi, Yoshihiro Furuichi, Yoshitaka Kasai, Hirohito Takeuchi, Yuu Yoshimasu, Katsutoshi Sugimoto, Ikuo Nakamura, Takao Itoi
A 27-year-old woman with colon cancer and liver metastasis was referred to our hospital. Colectomy and colostomy were performed to improve her ileus. Following 13 sessions of oxaliplatin-based chemotherapy (OC) with mFOLFOX6 + bevacizumab, thrombocytopenia and frequent peristomal bleeding occurred. Computed tomography showed severe ascites, splenomegaly, significant collateral veins around the stoma, and severe stenosis of the hepatic veins (HV) and inferior vena cava (IVC). Ultrasound elastography showed high liver (and spleen) stiffness values...
January 9, 2018: Clinical Journal of Gastroenterology
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