Peritoneo-Vesical Shunt: A Feasible Therapeutic Alternative for Refractory Ascites in the Low-Income Setting

Introduction: Schistosomiasis is a tropical parasitic disease with a very high prevalence worldwide, carrying a considerable risk for serious morbidity and mortality. Hepatic schistosomiasis may lead to chronic ascites due to portal hypertension (Increased hydrostatic pressure due to periportal fibrosis). Presentation of Case: We describe the case of a 67-year-old African female with refractory ascites secondary to hepatic schistosomiasis, causing her respiratory distress. At least mid-term, she was successfully treated with a peritoneo-vesical shunt, allowing the controlled passage of ascitic fluid from the peritoneum into the bladder, enabling her to “urinate” the liquid, releasing the abdominal pressure and improving her respiratory status. She was able to return to her normal activities during months postoperatively. Discussion: Schistosomasis is quite prevalent in tropical endemic areas, leading to serious complications. Patients with hepatic schistosomiasis develop secondary ascites, which is frequently refractory to standard medical treatment. Surgical procedures are required to improve the patients quality of life. Although the idea of using a shunt to evacuate peritoneal fluid into the bladder has been reported in a clinical trial, to our knowledge, no previous report of the use of a self-devised, inexpensive, controlled peritoneo-vesical shunt for the treatment of refractory ascites secondary to hepatic schistosomiasis in the low income setting has been previously described in the literature. We propose herein a novel and inexpensive surgical approach that allows the extraction of fluid from the peritoneal cavity, eliminating the liquid through normal urination, and improving the quality of life of the patient. Conclusion: Even though a wide range of surgical approaches has been devised for the management of refractory ascites, none has so far considered the particularities of resource-limited environments. We believe this to be an innovative and feasible surgical alternative for the management of refractory ascites in the low-income setting.