Intractable hepatic hydrothorax eliminated by thoraco-peritoneal connection

Abstract

Rationale: 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. Patient concerns: 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. Diagnoses: 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. Interventions: A thoracic drainage catheter and an abdominal puncture indwelling needle were connected to allow the pleural effusion to continuously flow into the abdominal cavity. Outcomes: 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. Lessons: 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.