Chronic peritoneal indwelling catheters for the management of malignant and nonmalignant ascites

Abstract

Ascites is a debilitating condition affecting patients with end-stage liver disease and advanced abdominal malignancies. Serial paracentesis can reduce symptoms in these patients; indwelling peritoneal catheters provide an alternative approach that allows patients to manage their symptoms at home. A literature search was conducted to identify studies with at least 20 patients published in the last 15 years that reported indwelling catheter placement in patients with chronic ascites. Fourteen studies with 957 patients (687 with malignancy and 270 with cirrhosis) were reviewed. Symptom improvement was reported in all studies. The most common complication in patients with malignant ascites was catheter dysfunction (39/687). Infection rates for patients with malignancy and patients with nonmalignant ascites were 5.4% (37/687) and 12.2% (33/270), respectively. Infection risk significantly increased with devices in place for >12 weeks. The average survival time after catheter placement was 7.2 weeks for patients with malignancy and 164 weeks for patients without malignancy. In conclusion, indwelling peritoneal catheters are an effective alternative to paracentesis for palliation in patients with refractory ascites. Peritonitis is a definite risk in patients with nonmalignant ascites in whom prolonged use is expected.

Use of indwelling pleural/peritoneal catheter in the management of malignant ascites: a retrospective study of 48 patients

“…In one patient, the catheter was removed by the treating clinician immediately following the diagnosis of peritonitis; it was not due to failure of antibiotic therapy. This incidence is lower than that of non‐tunnelled peritoneal catheters and similar to that reported for IPCs in malignant pleural effusion …”

“…Subsequently, several case series have adapted use of an indwelling pleural catheter (IPC) in malignant ascites wherein an IPC is inserted intra‐peritoneally after tunnelling (herein called indwelling peritoneal catheter (IPeC)). The published efficacy and safety results of IPeC are promising with a reduced need of further LVP, an improvement of symptoms and QoL and a low risk of complications including infection (5.4%) . This is the first Australian report on the experience of placing an IPeC for management of recurrent malignant ascites.…”

“…Previous studies have examined the efficacy of ambulatory care of non‐tunnelled indwelling peritoneal devices . These methods were complicated by high rates of catheter‐related sepsis (43.3%) and mechanical dysfunction requiring catheter replacement or removal (26%) .…”

Imaging of abdominal and pelvic infections in the cancer patient

“…Patients with advanced abdominal malignancies often develop refractory ascites. Indwelling peritoneal catheters can be an alternative to repeated paracentesis and have an infection rate of 5.4% in the setting of malignant ascites, with a significantly increased infection risk when left for more than 12 weeks [ 85 ]. Simple fluid collections or ill-defined fluid around devices can be due to seromas and post-surgical changes; however, the development of an enhancing wall or new gas pockets without recent intervention is concerning for abscess formation.…”

“…Simple fluid collections or ill-defined fluid around devices can be due to seromas and post-surgical changes; however, the development of an enhancing wall or new gas pockets without recent intervention is concerning for abscess formation. Certain types of peritoneal drainage catheters can be tunneled in the subcutaneous tissues, decreasing the rate of leaks and infection [ 85 ]. Additional peritoneal devices include peritoneal infusion catheters, dialysis catheters, ventriculoperitoneal shunts, and surgical drains; any of those can be complicated by peritonitis from translocation of skin flora or from bowel perforation, albeit the latter is rare.…”