Abstract
BackgroundPleuroperitoneal communication is a rare disorder that interferes with peritoneal dialysis. Although favorable results of thoracoscopic fistula closure have been reported, there are some cases in which the fistulas cannot be identified by thoracoscopy and the patients are forced to switch to hemodialysis.Case presentationWe present two cases of pleuroperitoneal communication in which diaphragmatic fistulas could not be identified thoracoscopically, but could be identified laparoscopically. Patient 1 had difficulty continuing peritoneal dialysis 9 months after its introduction due to right pleural effusion. Although we could not detect the fistula thoracoscopically, we could laparoscopically identify the fistula in the center of the tendon of the right diaphragm and closed the site from the thoracic side. Patient 2 developed dyspnea due to right pleural effusion 6 months after the introduction of peritoneal dialysis. We could not find the fistulas with a thoracoscopic approach, but could identify multiple diaphragmatic fistulas with a laparoscopic approach and close the sites from the thoracic side.ConclusionIn the surgical treatment of pleuroperitoneal communication, diaphragmatic fistulas can be identified laparoscopically even when thoracoscopic observation fails to find any fistulas.
Highlights
Pleuroperitoneal communication is a rare disorder that interferes with peritoneal dialysis
We grasped all of them laparoscopically and sutured and Conclusions Pleuroperitoneal communication is a rare condition encountered by 1.6–1.9% of patients with chronic renal failure undergoing peritoneal dialysis, and 50% of them are forced to switch to hemodialysis [1, 2]
It is thought that the transfer of peritoneal dialysis fluid through the fistula of the diaphragm to the thoracic cavity causes various symptoms and complicates continued peritoneal dialysis, pleural effusion can be caused by lymphatic migration from the abdominal cavity [5]
Summary
In the surgical treatment of pleuroperitoneal communication, diaphragmatic fistulas can be identified laparoscopically even when thoracoscopic observation fails to find any fistulas.
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