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Ascites after pleuroperitoneal shunting
J A Roukema1, H J Lobach, C van der Werken
1Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
Cancer
|August 15, 1990
Summary
Pleuroperitoneal shunts can treat malignant pleural effusion but may cause ascites. Replacing the shunt with a pleurovenous shunt resolved ascites and effusion, offering a viable alternative for managing complex cases.
Area of Science:
- Thoracic surgery
- Oncology
- Gastroenterology
Background:
- Malignant pleural effusion (MPE) is a common complication of advanced cancers.
- Conventional therapies for MPE may fail, necessitating alternative treatments.
- Pleuroperitoneal shunts are an option for refractory MPE, diverting fluid from the pleural space to the peritoneum.
Observation:
- A 59-year-old male patient with disabling MPE underwent pleuroperitoneal shunt insertion.
- Following shunt placement, the patient developed massive ascites.
- The pleuroperitoneal shunt was surgically replaced with a pleurovenous shunt.
Findings:
- Post-replacement, the patient's ascites resolved completely.
- Pleural effusion did not recur after the shunt revision.
- The patient survived for 6 months post-pleurovenous shunt insertion.
Implications:
- Pleuroperitoneal shunts, while effective for MPE, carry a risk of causing or exacerbating ascites.
- Pleurovenous shunting presents a successful alternative management strategy when pleuroperitoneal shunts lead to complications like massive ascites.
- This case highlights the importance of considering shunt type revision in managing refractory MPE with associated fluid management challenges.