Right hydrothorax found soon after introduction of continuous ambulatory peritoneal dialysis: thoracoscopic surgery for pleuroperitoneal communication

Abstract

Hydrothorax due to pleuroperitoneal communication is a rare complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). One of the problems of this complication is the need to cease CAPD, which means that the patient must shift completely to hemodialysis. Therefore, a quick, minimally invasive, and complete surgical repair of the pleuroperitoneal communication is required. We recently treated a patient who had developed a right hydrothorax soon after the introduction of CAPD. Clinical examination led to a diagnosis of pleuroperitoneal communication. The patient was successfully treated by complete thoracoscopic repair of the communication. We could precisely identify the defective site on the diaphragm using the dye-added CAPD solution method. CAPD was restarted 5 days after the operation, and there was no recurrence of hydrothorax after the operation.

Diaphragmatic fenestrations seen after peritoneal dialysis catheter placement: A rare cause of hydrothorax

“…8,9 Up to 90% of PD catheter patients that develop hydrothorax develop one on the right side. 10–12 Due to the negative pressure of the chest, these holes with peritoneal lining still intact allowed the dialysate to travel into the chest. It is well established that water and other liquids are able to transmit through the peritoneum.…”

Mechanical Complications of Peritoneal Dialysis

“…The primary etiology of hydrothorax in the PD patient is thought to be pleuro-peritoneal communication due to high peritoneal pressure upon dialysis in the presence of congenital or acquired defects in the diaphragm [59,61,62], although some cases are brought on by a malfunctioning or malpositioned catheter [63]. Notably, the presence of hydrothorax is right-sided in 90% of cases, as the left side of the diaphragm is partially supported by the heart and pericardium [64][65][66].…”

Surgical Repair of Pleuroperitoneal Communication with Continuous Ambulatory Peritoneal Dialysis

“…Several cases of video-assisted thoracoscopic surgery for PPC in CAPD patients have been published. 2,[5][6][7][8] However, few single-institutional reports discuss the details of surgery for PPC in CAPD patients including intraoperative findings, postoperative course, and outcomes. We experienced four surgical cases of PPC in CAPD patients since 2008, and our aim was to retrospectively analyze their clinical features as well as their intraoperative findings, postoperative course, and outcomes.…”