Cirrhosis affects more than 630,000 adults globally and can lead to development of ascites. Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative option for refractory ascites in patients who are ineligible or are waiting for liver transplants. However, this procedure can have serious complications. We present a case that highlights the development of a complex pleural effusion complicated by hemorrhagic shock and disseminated intravascular coagulation after TIPS in a 54-year-old man. Our case is the first to report such a complication and aims to provide awareness.

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