Thoracoscopic surgery for management of pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis

Abstract

Rationale: Pleuroperitoneal communication (PPC) has been reported to complicate continuous ambulatory peritoneal dialysis (CAPD). However, cases of patients in whom the results of the methylene blue dye test and peritoneopleural scintigraphy were negative and treatment was thoracoscopic surgery have been rarely reported. Patient concerns: A 58-year-old man with end-stage chronic renal failure who underwent CAPD presented with massive right-sided hydrothorax. The pleural fluid glucose level was high. Results of both the methylene blue dye test and peritoneopleural scintigraphy were negative. Diagnosis: The presence of end-stage chronic renal failure and diaphragm defects amenable to repair, which were identified during thoracoscopic surgery, indicated a definite diagnosis of PPC complicating CAPD. Interventions and outcomes: CAPD was performed twice after the defects were repaired during thoracoscopic surgery. There was no evidence that the repaired sites were leaking again, and the patient did not complain of any discomfort during the second CAPD. Lesson: Although special methods such as the methylene blue dye test and peritoneopleural scintigraphy may not be useful in some cases, thoracoscopic surgery is still effective and reliable in diagnosing and repairing diaphragmatic defects.

Minimally invasive surgery for pleuroperitoneal communication complicating peritoneal dialysis

“…And all patients existed a high pleural effusion glucose level and the pleural uid-to-serum glucose concentration difference exceeded 50 mg/dl. Some studies reported that the methylene blue test was negative in the tested patients [4,5], and could cause abdominal pain and even chemical peritonitis [9]. In the present study, the methylene blue test was positive among these tested cases and there was no evident discomfort in them.…”

“…Based on the close relationship between pleural effusion, clinical presentations and implementation of CAPD, the diagnosis is usually not di cult. The commonly preoperative diagnostic methods include: biochemical analysis of pleural effusion, the methylene blue dye test, isotopic scanning and contrast computerized tomography (CT) peritoneography and so on [5,6]. A high glucose concentration in the pleural effusion, which is similar to the level in the dialysis solution, indicates the diagnosis of PPC complicating CAPD [7].…”

Thoracoscopic and laparoscopic approach for pleuroperitoneal communication under peritoneal dialysis: a report of four cases

“…Since then, there have been several reports on the effectiveness of VATS. VATS (1) leads to early resumption of CAPD after surgery; (2) has a high intraoperative diagnosis rate and treatment results; (3) has a high safety threshold and can be performed even in patients with end-stage renal disease or hepatic failure; and (4) needs a pathological examination to confirm other causes (e.g., congenital defects, tumor, infection, or amyloidosis) for the pathogenesis of PPC [ 10 – 12 ]. However, no standard method is available for the intraoperative diagnosis or surgical procedures for PPC.…”

Surgical management of pleuro-peritoneal fistula in chronic renal failure patient—safety and effectiveness

“…Some centres employ localization techniques such as injection of methylene blue into peritoneal dialysate or use of intra-operative pneumoperitoneum to assist the localization of a potential diaphragmatic defect during VATS (10,11). However, this is not a routine practice at our centre.…”