Successful surgical decortication for trapped lung in a patient with decompensated cirrhosis

Abstract

Hepatic hydrothorax affects 5% to 10% of patients with cirrhosis. Infection of the pleural fluid may result in "trapped lung" physiology, which may jeopardize a patient's candidacy for liver transplant, and thus compromise long-term survival. We report a case of a patient with decompensated cirrhosis whose transplant candidacy hinged on management of his trapped lung, and who underwent successful decortication. In this particular case, surgical intervention was necessary not only as a "bridge" to transplant, but also because the patient's short-term survival was limited by ongoing infection, which was refractory to medical therapy alone. In conclusion, our case illustrates that this high-risk surgery can be successfully carried out in the decompensated cirrhotic, but that further research is needed to ascertain the role for surgical decortication specifically for the purpose of "bridging" a patient to transplant.