Hydrothcrax can be a cause of respiratory insufficiency and is needed adequate management and therapy. In this report, a patient of respiratory distress due to hydrothorax that occurred during explo-laparotomy and drainage of liver absceas under general anesthesia was treated with water seal drainage insertion in the 7th intercostal space and general management. Literatures was reviewed, and the importance of early recognition and vigorous treatment has been stressed.