The main indication of transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of variceal bleeding and refractory ascites in cirrhotic patients. In the presence of portal vein thrombosis in patients with cirrhosis, the risk of variceal bleeding increases and portal vein access during the procedure can be difficult. Various approaches including transhepatic, trans-splenic approach...

Objective: We evaluated whether nutritional status and long-term prognosis of patients with refractory hepatic ascites improved after treatment with tolvaptan. Methods: We retrospectively studied data for a total of 50 patients with hepatic ascites treated with tolvaptan from April 2011 to January 2016. Bloatedness was assessed by using the Japanese version of the support team assessment schedu...

Refractory ascites is a frequent complication of advanced cirrhosis and is associated with hepatorenal syndrome and hepatic hydrothorax. Large volume paracentesis and pleurodesis are regarded as first-line treatments in patients who do not respond adequately to diuretics. These treatments, however, do not prevent recurrence and carry the risk of worsening of the circulatory dysfunction leading ...

BACKGROUND Pleural or peritoneal effusions (ascites) are frequent in terminal stage malignancies. Medical management may be hazardous. METHODS A 60-year-old man with metastatic malignant melanoma presented refractory ascites as well as bilateral pleural effusions. After failure of the medical treatment, bilateral pleural aspiration and paracentesis became necessary two to three times a week. ...

Ascites is a major complication of cirrhosis. There are several evidence-based articles and guidelines for the management of adults, but few data have been published in relation to children. In the case of a pediatric patient with cirrhotic ascites (PPCA), the following questions are raised: How are the clinical assessment and ancillary tests performed? When is ascites considered refractory? Ho...

To the Editor: I read with interest the article on “Congenital chylous ascites and lymphedema in Down’s syndrome” published in Nov. 2012 issue [1]. However I would like to make some comments on the management of the given case. Association of Down syndrome with primary chylous ascites has been well documented in literature with previous published case reports [2, 3]. Though authors mention inve...

BACKGROUND The prevalence of portopulmonary hypertension (PPHTN) in patients with cirrhosis and refractory ascites is unknown. Its presence may preclude patients from receiving a transjugular intrahepatic portosystemic shunt or liver transplantation as a definitive treatment for their end stage cirrhosis. PURPOSE To determine the prevalence, possible aetiological factors, and predictive facto...

Two modifications of the standard method of treatment of ascites in chronic liver disease were investigated in three separate randomised trials involving a total of 201 patients. These modifications were (1) an unrestricted sodium intake and (2) limitation of diuresis to partial removal of ascites, to the point of relief of abdominal tension. Mean serum sodium fell significantly in all patient ...

Transjugular intrahepatic portosystemic shunts (TIPS) may worsen liver function and decrease survival in some patients. The Child-Pugh classification has several drawbacks when used to determine survival in such patients. The survival of 231 patients at 4 medical centers within the United States who underwent elective TIPS was studied to develop statistical models to (1) predict patient surviva...