Intractable hepatic hydrothorax eliminated by thoraco-peritoneal connection: A case report

Hepatic hydrothorax occurs in patients with decompensated cirrhosis and has a significantly adverse prognosis. However, several treatments, including indwelling pleural catheters, trans jugular intrahepatic systemic shunts, and automatic low-flow ascites pumps (Alfa pumps), have been utilized to relieve pleural effusion, but these methods often cause severe complications. We report the first case of using thoraco-peritoneal connection to manage hepatic hydrothorax in a cirrhotic patient without an unfavorable outcome.

A 55-year-old yellow-skinned female patient with alcoholic cirrhosis suffering from hepatic hydrothorax was admitted to the hospital. She presented with recurrent yellowish complexion, anorexia, chest tightness, and shortness of breath.

The definitive diagnosis encompassed liver failure, alcoholic cirrhosis in a decompensated state, esophageal varices, portal hypertension, ascites, hepatic hydrothorax, hypersplenism, cholecystolithiasis accompanied by cholecystitis, pulmonary nodules, and coronary atherosclerosis.

A thoracic drainage catheter and an abdominal puncture indwelling needle were connected to allow the pleural effusion to continuously flow into the abdominal cavity.

The patient showed rapid improvement in nutritional status, urine output, and a decrease in pleural effusion. Subsequently, pleural effusion did not increase, and the connection was removed 1 month later. Hydrothorax and ascites were examined by color Doppler ultrasound every 2 months. Liver function and coagulation function continued to improve. The patient resumed normal daily activities after 6 months.

The management of hepatic hydrothorax remains an area requiring further investigation. Thoraco - peritoneal connection might represent a medical strategy for the management of hepatic hydrothorax in cirrhotic patients with a favorable safety profile.