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Pleuroperitoneal Shunt in Recurrent Pleural Effusions

1986; Elsevier BV; Volume: 41; Issue: 6 Linguagem: Inglês

10.1016/s0003-4975(10)63071-8

1552-6259

Sayed Hussain,

Intestinal and Peritoneal Adhesions

Intractable recurrent pleural effusions remain a therapeutic problem.In most instances, instillation of a sclerosing agent into the pleural cavity does obviate the problem.However, in certain circumstances, the more drastic approach of performing a radical parietal pleurectomy must be used.The Denver peritoneovenous shunt was used in 3 patients to shunt the pleural fluids into the peritoneal cavity.In 2 patients, a complementary peritoneovenous shunt was also done.Control of intractable pleural effusion was achieved in all patients.The concept of the pleuroperitoneal shunt takes into consideration the ease of shunting the pleural fluid into the peritoneal cavity from where the fluid is readily reabsorbed by the large peritoneal surface.The shunt can be placed with the patient under local or general anesthesia. Those humors which ought to be evacuated should be directed whither they have a tendency, and through convenient passages. Hippocrates [l]Recurrent intractable pleural effusion due to benign or malignant disease poses a therapeutic challenge.Control of effusion after failure of medical treatment requires repeated thoracentesis or insertion of a closed thoracostomy chest tube.Although most effusions can be controlled by infusing sclerosing agents into the pleural cavity to obliterate the pleural space, this is not successful in every instance.In such cases, management of the effusion is achieved by diverting the pleural effusion into the peritoneal cavity with or without a complementary peritoneovenous shunt. Material and Method Con cep fTwo facts-one physiological and one anatomic-were responsible for the development of this concept for treating pleural effusion.(1) Although there is a net negative pressure in the pleural cavity, accumulation of fluid changes that negative pressure into positive pressure.Pleural pressure was measured by a manometer at the time of thoracentesis in 10 patients.In large effusions (more than 500 mL), there was always outward continuous flow of pleural fluid not affected by breathing.The intrapleural pressure ranged between 7 and 15 cm H20.