The importance of the intestine in the production of ascites. The value of surgery for validating this concept and solving the problem

Abstract

The understanding of the mechanisms for the development of ascites has evolved over the years to include the liver, peritoneum, heart and kidneys, but not the intestine, as key players in its formation.
The pathophysiological role of the intestine as well as the possible clinical and surgical therapeutic options have been poorly described. In order to empirically validate this concept, we report the situation of a 39-year-old man with isolated thrombosis of the superior mesenteric vein and intestinal failure. The need to perform a surgical shunt led us to construct a shunt from a collateral vein of the superior mesenteric vein to the splenic vein. The reduction in pressure in the superior mesenteric venous system from 35 to 6 mm Hg resulted in resolution of clinical signs and symptoms within one month. This case study forces us to review the basic pathophysiological concepts of ascites formation, contributes to the description of a new type of shunt, and expands the surgical therapeutic options in the treatment of splanchnic venous hypertension.