If conventional therapy fails in patients with intractable malignant pleural effusion, the pleuroperitoneal shunt is a valuable alternative. In a 59-year-old man with disabling malignant pleural effusion, massive ascites developed shortly after insertion of a pleuroperitoneal shunt. This shunt was replaced by a pleurovenous shunt. The ascites disappeared, and pleural effusion did not recur. The patient died 6 months later.