Pleuroperitoneal Communication following Right Hepatectomy: Successful Treatment with a Combined Thoracoscopic and Laparoscopic Approach.

INTRODUCTION

Pleuroperitoneal communication (PPC) is an abnormal connection between the thoracic and abdominal cavities, allowing ascitic fluid to migrate into the pleural space and cause pleural effusion. Although PPC is a recognized complication in peritoneal dialysis patients, it is rarely reported as a postoperative complication.

CASE PRESENTATION: A 54-year-old female patient with a history of right hemicolectomy and right hepatectomy for ascending colon cancer and metastatic liver tumor developed persistent right pleural effusion 3 months postoperatively. She also had ovarian metastases, peritoneal dissemination, and malignant ascites. Despite treatment with diuretics and 2 attempts at pleurodesis, the pleural effusion persisted. A combined thoracoscopic and laparoscopic approach was performed. Intraoperatively, a diaphragmatic hernia with a pinhole defect was identified, suggesting migration of ascitic fluid into the thoracic cavity. Resection of the hernia sac and suture closure of the diaphragmatic defect were carried out. Postoperatively, the pleural effusion resolved, and her dyspnea improved.

CONCLUSIONS

In case of refractory pleural effusion following hepatectomy, PPC due to diaphragmatic defects should be considered, particularly in the presence of ascites. A combined thoracoscopic and laparoscopic approach is a viable surgical option for definitive treatment.