Pleuroperitoneal Leak Complicating Peritoneal Dialysis: A Case Series

Kennedy, Claire; McCarthy, Cormac; Alken, Scheryll; McWilliams, J; Morgan, Ross; Denton, Mark D.; Conlon, Peter J.; Magee, Colm

doi:10.4061/2011/526753

Cited by 26 publications

(34 citation statements)

References 13 publications

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“…Symptoms of hydrothorax usually involve respiratory distress, particularly dyspnea [1,2] -which was present in our patient -as well as diminished vesicular sounds on auscultation and pleural effusion on chest radiograph. However, the underlying mechanism of hydrothorax secondary to PD remains unknown.…”

Section: Discussion/conclusionmentioning

confidence: 52%

“…However, the underlying mechanism of hydrothorax secondary to PD remains unknown. 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: 75%

“…Hydrothorax secondary to a pleuroperitoneal fistula (PPF) is a rare complication of longterm peritoneal dialysis (PD); its incidence rate is 0.53% in children. While the underlying mechanism remains unknown, it is speculated to be associated with a pleuroperitoneal communication [1,2].…”

Section: Introductionmentioning

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: 52%

Section: Discussion/conclusionmentioning

confidence: 75%

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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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“…A sudden increase in intra-abdominal pressure opens a communication between the abdomen and the thorax, thereby allowing fluid to leak into the thorax. [ 5 , 13 , 15 ]…”

Section: Discussionmentioning

confidence: 99%

Scintigraphic peritoneography in the diagnosis of pleuroperitoneal leak complicating peritoneal dialysis

Harry¹,

Nyakale²,

Tinarwo

2020

Medicine

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A pleuroperitoneal leak (PPL) is a relatively rare complication of peritoneal dialysis (PD) and early diagnosis is essential. Patients suspected of a PPL usually present with dyspnea (marked during inflow of PD fluid) and tend to have transudative high glucose pleural effusions. The PPL scintigraphy (PPLS) is one of the methods for objectively proving a PPL. The effectiveness of PPLS as a noninvasive method of evaluating a suspected PPL and its effectiveness in the exclusion of a leak in patients with similarly presenting comorbidities was assessed. Patients suspected to have a PPL were considered for PPLS based on clinical presentation and pleural fluid analysis. Radiopharmaceutical was administered into the peritoneum via the dialysis port with the patient lying supine and immediate dynamic followed by delayed statics were acquired. Of the 27 scans reviewed, 70% were found to be positive with majority detected within 12 minutes of radiopharmaceutical administration with a high predominance occurring in the right chest ( P < .001). In PPLS-positive patients, when both chest X-rays and planar agreed on showing the right-sided chest predominance, the highest measurements of the pleural glucose:serum glucose ratio were recorded. A statistically significant correlation between the outcome of the scan and final decision on patient management was noted ( P < .01). The PPLS is an effective diagnostic tool for assessing PPLS. However, multicenter studies investigating its added value over other conventional methods are needed to establish it as a highly relevant diagnostic tool.

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“…Dialysate is infused into the peritoneal cavity via a tunnelled catheter and pleural effusions (particularly on the right) are a recognized complication due to the increased intraabdominal pressure in the context of a diaphragmatic defect. The reported incidence is under 2% of patients having peritoneal dialysis [63] and if persistent may require the patient to use an alternative method for renal replacement therapy. …”

Section: Pleural Complications From Abdominal Proceduresmentioning

confidence: 99%

Common iatrogenic pleural complications

Dunscombe

Maskell

2012

Curr Respir Care Rep

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All invasive pleural procedures have the potential to cause harm. Complications from pleural procedures include empyema, intercostal artery laceration, hemothorax, and pneumothorax as well as other organ puncture. Many of these complications will be life threatening and will increase morbidity and hospital length of stay. An understanding of iatrogenic pleural disease helps clinicians to appreciate how these risks can be minimized and complications managed promptly and effectively. This review systematically evaluates the current evidence and guidelines regarding iatrogenic pleural complications and their management. Whilst impossible to eliminate procedural risk entirely, complications will be reduced to a minimum by ensuring adequate medical training, use of pleural ultrasound, and adherence to guidelines and standard operating procedures (SOPs).

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Pleuroperitoneal Leak Complicating Peritoneal Dialysis: A Case Series

Cited by 26 publications

References 13 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

Scintigraphic peritoneography in the diagnosis of pleuroperitoneal leak complicating peritoneal dialysis

Common iatrogenic pleural complications

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