Peritoneopericardial Communication after Pericardiocentesis in a Patient on Continuous Ambulatory Peritoneal Dialysis with Dialysis Pericarditis

Abstract

A male patient aged 41 years had dialysis pericarditis with massive pericardial effusion in his 6-year on continuous ambulatory peritoneal dialysis (CAPD). Intensive hemodialysis failed to resolve the pericardial effusion. Pericardiocentesis via a subxiphoid approach was performed with placement of a pigtail catheter for drainage. A communication between peritoneal and pericardial cavities occurred, resulting in the leakage of the peritoneal dialysate into pericardial sac which was confirmed by a ^99mTc radionuclide scan. The fistula healed after removal of the catheter and discontinuation of CAPD. We suggest that pericardiocentesis via a subxiphoid approach for pericardial effusion should be cautiously exercised in CAPD cases for fear of peritoneopericardial fistula.

Dialysate leakage into pericardium in an infant on long-term peritoneal dialysis

“…In the face of the small size of the fistula and the repeated leaks experienced in the past, a surgical closure was precluded. Spontaneous closure of a pericardiocentesis-related peritoneo-pericardial fistula occurred in one patient [10], while a surgery-related fistula has been reported in a second patient. He developed life-threatening cardiac tamponade after resumption of PD [9].…”

“…This complication has hitherto been described only in two adult PD patients who had undergone cardiac surgery and pericardiocentesis [9,10] and who may have had insufficient tissue repair and local adhesions, resulting in tear stress.…”

Large pericardial effusion due to peritoneopericardial fistula

“…Other articles reported PPC secondary to trauma [5], peritoneal dialyses [6] and pericardiocentesis [7]. Olearchyk [8] described herniation of the omentum into pericardial sac secondary to congenital defect of the central tendon of the diaphragm with congenital fistula, associated to other congenital defects like bicuspid aortic valve and nervous system abnormalities.…”

Utility of Scintigraphy in Assessment of Noninfectious Complications of Peritoneal Dialysis

“…Leakage of dialysate fluid into the pericardial cavity is extremely rare, with only a few cases reported in the literature (30)(31)(32). The patient can present with shortness of breath on exertion, orthopnea, and sometime life-threatening cardiac tamponade (31).…”