[Treatment of cirrhotic ascites by means of venous concentrated reinjected of the peritoneal fluid]. / Tretiranje ciroticnog ascita venoznom koncentriranom reinjekcijom peritonealne tecnosti

Thanks to diuretics, adequate diet, and other measures, the treatment of cirrhotic ascites in recent years has brought better results. Nonetheless, a certain number of patients do not respond to the above mentioned treatment. Such patients are afflicted with so called Refractory Ascites on which diuretics have no effect. In recent years the concentrated continuous reinjection methods has been accepted. During a nine month period, we have treated and analyzed thirty patients with severe Hepatic Ascitogenic Cirrhosis. The results have shown: 8 patients with satisfactory improvement with one reinjection, in 2 patients Ascites did not reoccur; 6 patients died; 6 patients failed to return for a control reexamination; in 2 patients, ascites persisted even after repeated reinjections. The patients were given diuretics the third week following the reinjection, and were put on a low salt diet. Ascites reoccurred, and to a greater degree during the second third, and fourth month. A reduced sodium level was corrected by the reinjection and by the administration of NaCl during the reinjection. K and Cl levels did not change significantly. Urea levels, which were elevated in many cases were normalized. Ammoniums and Phenols also tended to normalize following reinjection. Bilirubin values were highly variable especially in two patients. One of whom had a severely damaged liver (direct bilirubin), the other of whom had bleeding varicoses of the esophagus (indirect bilirubin). Both of these patients died. In such cases reinjection should not be performed until the bilirubin values fall below 5 mgr %. Of the six patients who died, four died of unforeseen esophageal hemorrhaging. A larger number of patients grew more tolerant of diuretics. Preparation for a Portocaval Shunt with the reinjection method is of a special advantage because of an overall improvement in condition, making surgery possible. Complications resulting from reinjection were insignificant and transitory. As a whole, our results (sixteen patients in satisfactory condition), showed that Continuous Venous Reinjection of peritoneal fluid, even though a palliative method, represents a significant step forward in the treatment of Ascites in the severely ill.