Fatal pulmonary tumor embolization following peritoneovenous shunting for malignant ascites

Abstract

A 44-year-old white male with pseudomyxoma peritonei and intractable malignant ascites is described. This patient underwent three peritoneovenous shunt procedures utilizing first the LeVeen shunt and finally the Denver shunt in a surgical attempt at palliative decompression of his malignant ascites. The peritoneovenous shunts resulted in massive tumor embolization to the pulmonary vasculature, clinically asymptomatic disseminated intravascular coagulation, and partial thrombosis of the superior vena cava. The pulmonary tumor embolization was manifest clinically as moderate pulmonary hypertension with increased pulmonary vascular resistance and persistent hypoxia.

Malignant ascites. A comparison of peritoneovenous shunting and nonoperative management

“…Routine laboratory methods were used for blood coagulation, hematologic studies, and biochemical monitoring. Quality of life was measured by the re- Ovary (11)(12)(13)(14)(15)(16) All Gastrointestinal (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) ..........…”

Pleuropulmonary Involvement in Pseudomyxoma Peritonei

“…It is worthwhile mentioning a unique case report published by Smith et al 27 These authors described a 44-year-old man who underwent 3 sequential insertions of peritonealvenous shunts to decompress PP, which was due to a well-differentiated mucinous adenocarcinoma. The third of these, a Denver shunt, was inserted into the right saphenous vein at the authors' institution.…”

“…Impressively, both lungs manifested numerous bilateral intravascular tumor emboli in vessels ranging from medium-sized arteries to capillaries; there was no evidence of parenchymal involvement by tumor. 27 Roulet 28 described a 45-year-old man with PP related to what appeared to be a low-grade mucinous neoplasm of the appendix. After 4 years and several abdominal surgical procedures, soft tissue lesions of the third and seventh right intercostal spaces developed.…”

The LeVeen Shunt: Mechanisms of Action, Indications and Contraindications to Its Use

“…Tumor implants do occur along catheter size [60] and tumor embolization to the lungs is occasionally found at autopsy or can be the cause of death [62,63].…”