The Le-Veen shunt in ascites is done between peritoneum and:
**Core Concept**
The Le-Veen shunt is a type of peritoneovenous shunt used for the management of refractory ascites. It involves the creation of a communication between the peritoneal space and the superior vena cava to reduce abdominal pressure and alleviate symptoms.
**Why the Correct Answer is Right**
The Le-Veen shunt works by allowing ascitic fluid to drain from the peritoneal space into the superior vena cava, thereby reducing portal pressure and alleviating symptoms of ascites. The shunt is typically placed between the peritoneal space and the right atrium, which is a tributary of the superior vena cava.
**Why Each Wrong Option is Incorrect**
**Option A:** This is incorrect because the Le-Veen shunt is not typically placed between the peritoneum and the inferior vena cava. The inferior vena cava is a larger vein that drains blood from the lower body, and placing the shunt here would not be effective for reducing portal pressure.
**Option B:** This is incorrect because the Le-Veen shunt is not typically placed between the peritoneum and the hepatic vein. The hepatic vein drains blood from the liver into the inferior vena cava, and placing the shunt here would not be effective for reducing portal pressure.
**Option C:** This is incorrect because the Le-Veen shunt is not typically placed between the peritoneum and the portal vein. The portal vein carries blood from the gastrointestinal tract and spleen to the liver, and placing the shunt here would not be effective for reducing portal pressure.
**Clinical Pearl / High-Yield Fact**
The Le-Veen shunt is a relatively simple and effective procedure for managing refractory ascites, but it requires careful patient selection and monitoring to avoid complications such as thrombosis and infection.
**Correct Answer:** D.