Thoracoscopic repair of peritoneopleual communication with a giant diaphragmatic bullae in a patient with liver cirrhosis; report of a case

Hepatic hydrothorax is defined as pleural effusion in patients with a cirrhotic liver. The pleural effusion occurs due to ascites flowing to the pleural cavity through a diaphragmatic communication. Recent literature has described the usefulness of a thoracoscopic repair and has shown that it can control pleural effusion very efficaciously. The patient was a 65-year-old woman who complained of dyspnea and was admitted to our hospital. A chest X-ray revealed marked right pleural effusion. We injected indigo carmine intraperitoneally and observed indigo carmine-colored pleural effusion; thus peritoneopleural communication was validated. After the failure of thoracic drainage and pleurodesis with minocycline hydrochloride, thoracoscopic surgery was performed 5 weeks after hospitalization. Obvious bulla formation was observed on the diaphragm, which was immediately resected with linear staplers. The postoperative course was excellent without any recurrence of pleural effusion.