- First reported case of thoraco-peritoneal connection successfully treating intractable hepatic hydrothorax in a patient with decompensated alcoholic cirrhosis.
- Procedure yielded rapid nutritional and urine output improvement, decreased pleural effusion, removal after one month, and restoration of daily activities by six months.
- Thoraco-peritoneal connection may offer a favourable and safe therapeutic option for hepatic hydrothorax, warranting further investigation.
Medicine (Baltimore). 2026 Sep 18;105(38):e50685. doi: 10.1097/MD.0000000000050685.
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.
PMID:42760719 | DOI:10.1097/MD.0000000000050685
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