A CASE OF INTRACTABLE HEPATIC PLEURAL EFFUSION WHICH COULD BE CONTROLLED BY THE PLEURAL-CAVAL SHUNT PUMP

Abstract

We often experince the case of pooling of transudate fluid in the body cavity due to hypoalbuminemia at the time of decompensatory period in liver cirrhosis. Generally the first choice of the method of treatment is the medical treatment using the technique of transfusion including protein in such a case. But we occasionally encounter intractable cases resistant to any medical treatments. Recently, we exprienced an intractable case of pleural effusion being well controlled with the pleuralcaval shunt (the following “implantation of thoracic pomp”). A 76-year-old woman was under observation on an ambulant basis after subtotal gastrectomy for an early gastric cancer in April 1994, when preoperative examinations revealed hepatitis type C, hepatitis type B, and liver cirrhosis. About one year later she complained of dyspnea. With chest X-ray examination the patient was diagnosed left-sided pleural effusion. We performed the drainage of the pleural cavity and tried twice to make adhesion of the pleura by infusing OK432 into the left pleural space. However, the speed of pooling of pleural effusion was too high to make an adequate pleural adhesion to control pleural effusion. We dicided to performe the implantation of pleural caval shunt pomp to control tension pleural effusion. Now, 2 months after implantation of pleural caval shunt pomp, pleural effusion is well controlled without any symptoms.