Massive peritoneal effusion following hip arthroscopy: a case report and review of the literature

Peritoneal effusion is a rare but potentially life-threatening complication. This article aims to report two cases of massive peritoneal effusion following hip arthroscopy, both of whom had favorable outcomes.

Two patients of Han Chinese ethnicity underwent hip arthroscopy under epidural anesthesia. Case 1 was a 49-year-old female who had a right acetabular labral tear and cyst, while Case 2 was a 69-year-old female who had left hip femoroacetabular impingement. Both surgeries used standard anterolateral and anterior approaches with 18 L and 24 L of irrigation fluid at 100 mmHg pressure, respectively. During surgery, both patients developed severe abdominal distension; Case 2 also experienced transient hemodynamic instability. Imaging results confirmed extensive fluid accumulation in the abdominal and pelvic cavities. Both patients were treated with diuretics (furosemide), gastrointestinal motility regulators (trimebutine maleate), and intermittent enemas. Case 1 urinated approximately 3000 mL, and Case 2 urinated 1500 mL. Follow-up imaging results showed significant reduction in fluid accumulation, and both were discharged without further complications.

Large peritoneal effusion after hip arthroscopy is a rare but serious complication that can lead to intra-abdominal hypertension. Surgeons should be careful, especially in patients with prior abdominal surgeries or prolonged procedures near the iliopsoas tendon sheath, and take preventive measures such as minimizing perfusion pressure and monitoring vital signs.