Pigtail Catheter: A Less Invasive Option for Pleural Drainage in Egyptian Patients with Recurrent Hepatic Hydrothorax

Abstract

Background and Aims. Treatment of hepatic hydrothorax is a clinical challenge. Chest tube insertion for hepatic hydrothorax is associated with high complication rates. We assessed the use of pigtail catheter as a safe and practical method for treatment of recurrent hepatic hydrothorax as it had not been assessed before in a large series of patients. Methods. This study was conducted on 60 patients admitted to Tanta University Hospital, Egypt, suffering from recurrent hepatic hydrothorax. The site of pigtail catheter insertion was determined by ultrasound guidance under complete aseptic measures and proper local anesthesia. Insertion was done by pushing the trocar and catheter until reaching the pleural cavity and then the trocar was withdrawn gradually while inserting the catheter which was then connected to a collecting bag via a triple way valve. Results. The use of pigtail catheter was successful in pleural drainage in 48 (80%) patients with hepatic hydrothorax. Complications were few and included pain at the site of insertion in 12 (20%) patients, blockage of the catheter in only 2 (3.3%) patients, and rapid reaccumulation of fluid in 12 (20%) patients. Pleurodesis was performed on 38 patients with no recurrence of fluid within three months of observation. Conclusions. Pigtail catheter insertion is a practical method for treatment of recurrent hepatic hydrothorax with a low rate of complications. This trial is registered with ClinicalTrials.gov Identifier: NCT02119169.

A study of efficacy and safety of tranexamic acid versus iodopovidone in pleurodesis via pigtail catheter in management of recurrent pleural effusion

“…The origin of effusion in group I was malignant pleural effusion in 15 patients (60%) and hepatic hydrothorax in 10 patients (40%), and in group II was malignant pleural effusion in 11 patients (44%) and hepatic hydrothorax in 14 patients (56%) as seen in Table 4. Hepatic hydrothorax as well as malignant pleural effusion is recurrent and rapidly accumulative, so many clinicians are convinced to place indwelling pleural catheters (IPCs) for non-malignant effusions like hepatic hydrothorax, sometimes spontaneous mechanical pleurodesis occurs, sometimes chemical pleurodesis with sclerosing agent is needed [13][14][15][16][17][18][19][20].…”

Hepatic hydrothorax: An update and review of the literature

“…So, the use of the first was successful in 48 out of 60 patients with refractory HH. The most significant complications were occlusion (3.3%) of the catheters and pain around their location (20%)[ 36 ]. The Pleurx ® drainage system showed good results in five of the eight patients, who had it installed as a “bridge” before TIPS or liver transplantation.…”

Efficacy and Safety of Indwelling Pleural Catheters in Management of Hepatic Hydrothorax: A Systematic Review of Literature

“…In total, we investigated data from 111 patients. The mean age of patients was reported in three studies (Chalhoub et al [ 13 ], Chen et al [ 16 ] and Sharaf-Eldin et al [ 15 ]) and ranged from 42 to 59 years. The majority of these patients were male (61.8%).…”

“…As for secondary outcomes, the frequency of pneumothorax during or after the procedure was 0 out of 92 patients (0%); pain at insertion site was reported in 12 out of 60 patients (20%), catheter blockage in two out of 68 patients (2.9%), pleural fluid infection in five out of 111 patients (4.5%) and catheter-site cellulitis in one out of 32 patients (3.1%). Re-accumulation of pleural fluid after catheter removal was mentioned in one study (Sharaf-Eldin et al [ 15 ]), wherein 12 out of 60 patients (20%) developed a recurrence of pleural effusion.…”