Massive Pneumoperitoneum: A Late Complication of the Denver Pleuroperitoneal Shunt

Foroulis, Christophoros N.; Desimonas, Nikolaos

doi:10.1016/j.athoracsur.2005.06.021

Cited by 12 publications

(7 citation statements)

References 1 publication

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“…8,9) However, we could not control chylothorax by using a pleuroperitoneal shunt in the present case. The most likely cause is that the amount of pleural effusion produced in the left cavity was more than the amount that the peritoneal cavity could absorb due to small body size.…”

Section: Discussionmentioning

confidence: 69%

A Case of Successful Therapy by Intrapleural Injection of Fibrin Glue for Chylothorax after Lung Transplantation for Lymphangioleiomyomatosis

Oishi

Hoshikawa

Sado

et al. 2017

ATCS

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A 37-year-old woman underwent bilateral lung transplantation for lymphangioleiomyomatosis. Dense pleural adhesions due to past pleurodesis for chylothorax were observed and dissected in both thoracic cavities. The patient developed chylothorax after transplant. Chylothorax in the right thoracic cavity was successfully treated by conventional pleurodesis; however, pleural effusion from the left thoracic cavity was not reduced. According to fluoroscopic images obtained by injecting a contrast medium through the chest tube, the remaining pleural space in the left thoracic cavity was small and localized in the lower region adjacent to the mediastinum. We opted to fill this space with fibrin glue; we injected fibrinogen and thrombin solution into the space through the chest tube. We performed fibrin glue treatment three times and pleural effusion was dramatically decreased. We removed the chest tube on day 107 post-transplant. No recurrent chylothorax has been recorded for 10 years after lung transplantation.

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Section: Discussionmentioning

confidence: 69%

A Case of Successful Therapy by Intrapleural Injection of Fibrin Glue for Chylothorax after Lung Transplantation for Lymphangioleiomyomatosis

Oishi

Hoshikawa

Sado

et al. 2017

ATCS

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“…Originally introduced by Leveen et al [138] in the 1970s, peritoneovenous shunting was a method devised whereby continuous abdominal paracentesis was facilitated by recirculating protein-rich ascitic fluid back into the central circulation by means of a surgically placed subcutaneous cannula with a one-way pressure valve. Although some still consider peritoneovenous shunting as a treatment of last resort in diuretic-resistant patients with contraindication to TIPS or pediatric serial paracentesis [139], the procedure has been virtually abandoned because of well-documented serious adverse events including shunt occlusion, peritoneal infection, ascitic leak, bleeding, disseminated intravascular coagulation, pneumothorax, and pneumoperitoneum [113,[140][141][142][143][144]. Despite an insignificant trend toward earlier relief of ascites compared with TIPS for patients [143], the host of complications and risk of early shunt dysfunction have made peritoneovenous shunts nearly obsolete.…”

Section: Volume Expansionmentioning

confidence: 99%

“…Despite the improvement in renal function, only 1 patient in the peritovenous shunt group had prolonged survival (210 days), whereas in the remainder survival was 13.8 AE 2 days compared with 4.1 AE 0.6 days in the medical therapy group. The procedure has been virtually abandoned because of well-documented serious adverse events including shunt occlusion, peritoneal infection, ascitic leak, bleeding, disseminated intravascular coagulation, pneumothorax, and pneumoperitoneum [113,[140][141][142][143][144]. Despite an insignificant trend toward earlier relief of ascites compared with TIPS for patients [143], the host of complications and risk of early shunt dysfunction have made peritoneovenous shunts nearly obsolete.…”

Section: Volume Expansionmentioning

confidence: 99%

ACR Appropriateness Criteria® Radiologic Management of Portal Hypertension

Imaging

Pinchot

Kalva

et al. 2021

Journal of the American College of Radiology

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Cirrhosis is a heterogeneous disease that cannot be studied as a single entity and is classified in two main prognostic stages: compensated and decompensated cirrhosis. Portal hypertension, characterized by a pathological increase of the portal pressure and by the formation of portal-systemic collaterals that bypass the liver, is the initial and main consequence of cirrhosis and is responsible for the majority of its complications. A myriad of treatment options exists for appropriately managing the most common complications of portal hypertension, including acute variceal bleeding and refractory ascites.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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“…Shunts are placed in the chest with a catheter transporting chyle from the chest to the peritoneal cavity. Complications of pleuroperitoneal shunts include shunt occlusion, pneumoperitoneum, infection and shunt migration (52).…”

Section: Pleuroperitoneal Shuntsmentioning

confidence: 99%

Postoperative chylothorax

Al-Sahaf¹

2021

Shanghai Chest

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Fortunately, the incidence of postoperative chylothorax is low. Postoperative chylothorax can result from iatrogenic injury to either the thoracic duct or its tributaries during thoracic procedures.Thoracic duct injury has been reported following several thoracic procedures including oesophagectomy, pulmonary resections, mediastinal lymph node dissection and aortic surgery. Knowledge of the anatomical course and variations in ductal anatomy reduces the risks of injury during surgery. Chylothorax results in metabolic derangement, hypovolaemia, acidosis, malnutrition and immunosuppression. Undiagnosed, postoperative chylothorax could have devastating effects with significant morbidity and a mortality of up to 30%. Early diagnosis is therefore imperative to enable prompt and aggressive management. If postoperative chylothorax is suspected, it should be immediately investigated to confirm the diagnosis. Familiarity with the diagnostic and management procedures are therefore important to help reduce the complications of postoperative chylothorax. There are several options for managing postoperative chylothorax. These include conservative treatment, interventional procedures and surgical re-exploration for the closure of leak or duct ligation. Successful management is often achieved using a combination of these approaches. Intraoperative prophylactic thoracic duct ligation has been suggested to reduce the incidence of chylothorax following highrisk procedures.

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Massive Pneumoperitoneum: A Late Complication of the Denver Pleuroperitoneal Shunt

Cited by 12 publications

References 1 publication

A Case of Successful Therapy by Intrapleural Injection of Fibrin Glue for Chylothorax after Lung Transplantation for Lymphangioleiomyomatosis

A Case of Successful Therapy by Intrapleural Injection of Fibrin Glue for Chylothorax after Lung Transplantation for Lymphangioleiomyomatosis

ACR Appropriateness Criteria® Radiologic Management of Portal Hypertension

Postoperative chylothorax

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