Peritoneal dialysis (PD) is an established renal replacement therapy for patients with end-stage renal disease (ESRD), and it is an effective mean of treatment for maintaining patients' residual renal function and their quality of life (QOL). However, acute hydrothorax is one of the complications of PD that can lead to discontinuation of PD and a switch to hemodialysis. We report a case of a 51-year-old woman with ESRD secondary to chronic glomerulonephritis who was placed on intermittent PD (IPD) and developed right-sided acute hydrothorax one month later. Scintigraphy with technetium-99 m macroaggregated human albumin (Tc-99 m MAA) revealed presence of a pleuroperitoneal communication, and treatment by autologous blood pleurodesis was performed twice. However, the treatment was ineffective, and two months after the onset of the hydrothorax, we performed video-assisted thoracoscopic surgery (VATS), using collagen fleece coated with fibrin glue to seal off the communication. The surgical procedure was followed by complete resolution of the hydrothorax. It was possible to resume the PD about one month postoperatively, and there has been no evidence ofrecurrence of the hydrothorax. VATS with collagen fleece was effective in treating acute hydrothorax secondary to a pleuroperitoneal communication that developed as a complication of PD.