134\u2005Case report: indwelling peritoneal catheter insertion for management of massive ascites in a young patient with congestive cardiac failure

Abstract

Background Indwelling peritoneal catheters are widely available for patients with malignant ascites, but are not usually used in patients with non-malignant disease. Most patients with non-malignant ascites have liver failure and are managed with regular temporary drains. A small proportion have cardiac ascites which is usually managed with diuretics and fluid restriction Case Ms X was a 28 year old lady with massive ascites due to cardiac failure from ischaemic cardiomyopathy. She was no longer a candidate for cardiac transplantation and had frequent hospital admissions due to decompensation with pulmonary oedema despite oral diuretics. Her reported quality of life and functional ability was poor. She was admitted to the hospice for consideration of continuous subcutaneous infusion (CSCI) of furosemide due to worsening symptoms. Pulmonary oedema at the time of admission was managed with IV furosemide given in divided doses as short infusions. Her abdomen was distended and ward ultrasound scan revealed large volume ascites. Following literature review and discussion of the risks and potential benefits, a tunnelled ascitic drain was sited by an Interventional Radiologist. Over the course of 16 days, 21 litres was drained with reduction in abdominal distension and leg oedema; her mobility and quality of life improved. To support management at home, Ms X’s mother learned to perform the drainage independently. Bloods were monitored weekly and she was readmitted for IV albumin when blood albumin fell to 22 g/l. The volume of ascites drained gradually reduced to nothing and the drain was removed due to concerns about infection after sepsis developed. The ascites did not recur and Ms X had no further admissions for decompensation of CCF. She died at home 10 weeks after the drain removal Conclusion Permanent ascitic drain insertion can reduce diuretic use and frequency of decompensations in patients with large volume cardiac ascites.