DISSEMINATED INTRAVASCULAR COAGULATION FOLLOWING PERITONEO-VENOUS (LEVEEN) SHUNT

  • 1 January 1981
    • journal article
    • research article
    • Vol. 11  (1) , 8-12
Abstract
LeVeen shunts [10] were inserted into 9 patients with intractable ascites. Coagulation studies were performed to determine the incidence, severity and clinical importance of disseminated intravascular coagulation (DIC) in the initial post-operative period. Two of the shunts failed to function in the immediate post-operative period and the clotting profiles of these patients were unchanged by surgery. The remaining shunts had good initial flow. In all patients, there was a deterioration in the coagulation profile consistent with DIC. In 4 of these patients, this was associated with clinical evidence of impaired hemostasis which required surgical ligation of the shunt in 2 as an emergency measure. The other 2 patients died as a direct consequence of their bleeding. Of the 8 initially patent shunts, 1 blocked spontaneously and 3 others were surgically ligated in the early post-operative period. The clotting abnormalities of all patients returned to pre-operative levels with the cessation of flow through the shunts. Four patients had continued shunt patency during their hospital stay. Titers of fibrin degradation products remained elevated. Adequate flow through the peritoneovenous shunt apparently causes laborotory evidence of DIC in all patients. Monitoring of the coagulation profile is a good index of continued shunt patency at least in the early post-operative period. DIC may account for the high spontaneous blockage rate.