Recurrent pleuroperitoneal leak caused by diaphragm blebs in a peritoneal dialysis patient: a case report with literature review

Fujino, Yoshihiko; Kawada, Noritaka; Ito, Katsukiyo; Katsura, Hiroshi; Maeda, Hajime; Mitsumoto, Kensuke; Uzu, Takashi

doi:10.1186/s41100-018-0181-8

Cited by 4 publications

(8 citation statements)

References 14 publications

(23 reference statements)

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“…Hydrothorax is postulated to be associated with a PPF that is formed secondary to a congenital diaphragmatic defect or an acquired defect, resulting in the movement of dialysate from the peritoneum to the pleural cavity [1,2]. Alteration in the pleuroperitoneal pressure gradient secondary to PD that occurred over a 21-month period in our patient may have triggered PPF [5].…”

Section: Discussion/conclusionmentioning

confidence: 73%

“…CT peritoneography is advantageous for depicting the entire peritoneal and thoracic cavity with minimal costs compared with magnetic resonance peritoneography [6]. Peritoneal scintigraphy may be performed using technetium-99m macroaggregated albumin ( 99m Tc-MAA) as the contrast agent [5]. We used iohexol as the contrast agent, which highlights a characteristic imaging feature of PPF.…”

Section: Discussion/conclusionmentioning

confidence: 99%

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Effective Management of Peritoneal Dialysis-Associated Hydrothorax in a Child: A Case Report

Ambarsari

Bermanshah

Putra

et al. 2020

Case Rep Nephrol Dial

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Peritoneal dialysis (PD) confers many advantages, including a better quality of life for children with end-stage renal disease; however, the procedure is associated with several complications, including pleuroperitoneal leaks. Here, we report an unusual case of hydrothorax caused by long-term PD in a child, which was further complicated by pneumonia. A 9-year-old boy who had received CAPD for 22 months presented with dyspnea, swelling, and increased body weight. Chest tube drainage yielded 500 mL of transudative fluid. Computed tomography peritoneography revealed increased outflow from the peritoneum to the pleural cavity. PD was suspended, and hemodialysis (HD) was initiated. Video-assisted thoracoscopic surgery was performed; however, because the patient had pneumonia during hospitalization, pleural adhesions with a septated appearance occurred. This resulted in difficulties identifying pleuroperitoneal fistula (PPF). Right pleural effusion resolved following pleurodesis using bleomycin. Ambarsari et al.: Effective Management of PD-Associated Hydrothorax in a Child 19Regular HD was performed for 10 weeks, and PD was subsequently reinitiated. There was no recurrence of hydrothorax during long-term follow-up. We suspect that the underlying mechanism of hydrothorax in our patient was associated with a PPF that formed either due to a congenital diaphragmatic defect or an acquired defect, resulting in dialysate leakage. Our case demonstrates that a temporary switch from PD to HD, accompanied by pleurodesis, may help resolve hydrothorax that occurs as a complication of long-term PD.

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Section: Discussion/conclusionmentioning

confidence: 73%

Section: Discussion/conclusionmentioning

confidence: 99%

Effective Management of Peritoneal Dialysis-Associated Hydrothorax in a Child: A Case Report

Ambarsari

Bermanshah

Putra

et al. 2020

Case Rep Nephrol Dial

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“…The mechanism underlying the development of ascites in the pleural effusion is considered to be related to the increased intra-abdominal pressure due to the accumulation of PD dialysate or liver cirrhosis in the presence of a diaphragmatic defect, such as those around the major vessels and the esophagus or through the diaphragmatic foramina or lymphatics [1,2]. Previous studies have reported that once blebs that form on fragile regions in the diaphragm due to intra-abdominal pressure are ruptured, they could cause a hydrothorax and a one-way valve [9,10].…”

Section: Discussionmentioning

confidence: 99%

Pleuroperitoneal communication after bacterial peritonitis and total gastrectomy for gastric neuroendocrine tumors: a case report and brief literature review

et al. 2020

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Background Peritoneal dialysis (PD) is associated with various complications, some of which may result in its discontinuation. Pleuroperitoneal communication (PPC) is commonly recognized by the presence of a diaphragmatic defect and pressure elevation in the abdominal cavity due to the dialysate. PPC is unpredictable and its presence prevents the continuation of PD. We present the clinical course and pathological findings of PPC in a PD patient after bacterial peritonitis and total gastrectomy for gastric neuroendocrine tumors. We provide a brief review of PD-related complications that develop due to a non-infectious pathology, including those related to catheter use and an elevated intra-abdominal pressure. Case presentation A 65-year-old Japanese man, who had been receiving PD treatment for 1 year, visited our hospital owing to a cloudy dialysate. Bacteria were detected in the dialysate. He had been previously diagnosed with gastric neuroendocrine tumors and gastrectomy had been planned. On admission, we started a 14-day antibiotic treatment for PD-related peritonitis. The patient showed a good clinical course. Gastrectomy was performed as planned, and the postoperative course was uneventful. During the perioperative period, PD was temporally changed to hemodialysis. Five weeks after the gastrectomy, PD treatment was resumed with gradual increase in the exchange volume. After returning to PD overnight, using an automated peritoneal dialysis machine, the patient complained of breathing difficulty and he gained weight. Right-sided pleural effusion was observed on a chest radiograph, and PPC was confirmed by scintigraphy when a mixture of technetium-99m and dialysate was seen entering the right hemithorax within 120 min. The patient did not consent to surgery for the PPC and he hoped to continue to receive PD treatment conservatively. We advised the patient to undergo dialysate exchange in a semi-seated position, and he was prohibited from lying down during the daytime. He continued PD treatment without signs of pleural effusion and over-volume. Conclusions This case of PPC occurring after bacterial peritonitis and total gastrectomy for gastric neuroendocrine tumors in a PD patient demonstrates the necessity of recognizing the PPC pathology in PD management and establishing methods for preventing PPC development after bacterial peritonitis or surgical procedures.

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“…Se ha postulado que el hidrotórax se asocia con una FPP que se forma como consecuencia de un defecto congénito del diafragma o un defecto adquirido, lo que genera el movimiento del dializado del peritoneo a la cavidad pleural [1, 2]. Una alteración en el gradiente de presión pleuroperitoneal secundaria a la DP que ocurrió durante un periodo de 21 meses pudo haber disparado la FPP en nuestro paciente [5].…”

Section: Discusión/conclusiónunclassified

“…La peritoneografía mediante TC es ventajosa para retratar la cavidad peritoneal y torácica completa, con costos mínimos en comparación con la peritoneografía mediante resonancia magnética [6]. La gammagrafía peritoneal puede realizarse utilizando albúmina macroagregada con tecnecio-99 como agente de contraste [5]. En este caso empleamos iohexol como agente de contraste, que realza el rasgo de imagen característico de la FPP.…”

Section: Discusión/conclusiónunclassified

Tratamiento efectivo de hidrotórax asociado con la diálisis peritoneal en un niño: reporte de un caso

et al. 2021

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La diálisis peritoneal (DP) ofrece muchas ventajas, entre ellas una mejor calidad de vida para niños con enfermedad renal en fase terminal; sin embargo, el procedimiento está asociado con varias complicaciones, incluyendo filtraciones pleuroperitoneales. En este trabajo reportamos un caso inusual de hidrotórax causado por el uso prolongado de DP en un niño, complicado con neumonía. Un niño varón de 9 años que había recibido DP ambulatoria de manera continua (DPAC) por 22 meses presentó disnea, hinchazón e incremento de peso corporal. El drenaje del tórax produjo 500 mL de fluido trasudativo. La peritoneografía mediante tomografía computada reveló un incremento del flujo del peritoneo a la cavidad pleural. Se suspendió la DP y se inició la aplicación de hemodiálisis (HD). Se practicó cirugía toracoscópica asistida por video; sin embargo, luego de que el paciente sufrió neumonía durante la hospitalización se observaron adherencias pleurales con apariencia septada. Como resultado, fue difícil identificar una fístula pleuroperitoneal (FPP). El derrame pleural derecho se resolvió luego de la pleurodesis empleando bleomicina. Se realizó DH regular por 10 semanas y posteriormente se reinició la DP. No hubo recurrencia del hidrotórax durante el seguimiento a largo plazo. Sospechamos que el mecanismo subyacente del hidrotórax en nuestro paciente se asoció con una FPP resultante de un defecto congénito en el diafragma o a un defecto adquirido, que produjo la filtración del dializado. Nuestro caso demuestra que un cambio temporal de la DP a la HD, acompañado por pleurodesis, puede ayudar a resolver el hidrotórax que se presenta como complicación del uso prolongado de la DP.

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Recurrent pleuroperitoneal leak caused by diaphragm blebs in a peritoneal dialysis patient: a case report with literature review

Cited by 4 publications

References 14 publications

Effective Management of Peritoneal Dialysis-Associated Hydrothorax in a Child: A Case Report

Effective Management of Peritoneal Dialysis-Associated Hydrothorax in a Child: A Case Report

Pleuroperitoneal communication after bacterial peritonitis and total gastrectomy for gastric neuroendocrine tumors: a case report and brief literature review

Tratamiento efectivo de hidrotórax asociado con la diálisis peritoneal en un niño: reporte de un caso

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