Pleuroperitoneal Communication Research Articles

Pleuroperitoneal Communication: A Rare Complication of Peritoneal Dialysis Observed in an Ecuadorian Hospital

Pleuroperitoneal Communication: A Rare Complication of Peritoneal Dialysis Observed in an Ecuadorian Hospital

Examination of surgical treatment for pleuroperitoneal communication

Examination of surgical treatment for pleuroperitoneal communication

Durvalumab plus carboplatin-etoposide treatment in a patient with small-cell lung cancer on hemodialysis: a case report and literature review.

Little is known about the efficacy and safety of durvalumab plus carboplatin-etoposide treatment in patients with extensive-disease (ED) small-cell lung cancer (SCLC) on hemodialysis. Here, we present a case of a 67-year-old man with pleuroperitoneal communication on continuous ambulatory peritoneal dialysis who was diagnosed with ED-SCLC based on a cytological analysis of the peritoneal fluid. He was switched from peritoneal dialysis to hemodialysis and received durvalumab (1500mg/body on day 1) plus carboplatin (area under the concentration-time curve = 5, 125mg on day 1) and etoposide (50mg/m2 on days 1 and 3) as first-line therapy. During the first cycle, grade 2 anemia, grade 3 neutropenia, and grade 3 upper gastrointestinal bleeding occurred; therefore, durvalumab and reduced doses of carboplatin and etoposide were administered. No other severe adverse events occurred, and a partial response was observed after four cycles. Our findings indicate that durvalumab plus carboplatin-etoposide treatment is safe and effective even in patients on hemodialysis.

Pleuroperitoneal communication-associated pleuritis as an uncommon cause of fever of unknown origin in a child on peritoneal dialysis: a case report

Pleuroperitoneal communication (PPC) is a rare mechanical complication of peritoneal dialysis (PD), which causes dialysate to move from the peritoneal cavity to the pleural cavity, resulting in pleural effusion. Typically, PPC is discovered through pleural effusion in PD patients who are not in volume overload status. A unique characteristic of the pleural effusion caused by PPC is that it is not resolved by increasing ultrafiltration by dialysis. In this report, we present a 7-year-old girl with PD after birth with the history of various infectious PD-related complications, presenting with fever ongoing for 6 months. PPC-associated pleuritis was suspected as the cause of fever, which eventually developed after long-term PD and induced complicated pleural effusion, lung inflammation, and prolonged fever for 6 months.

Embryological, anatomical and clinical considerations on pleuroperitoneal communication.

The pleural and peritoneal cavity share many related features due to their common celomic origin. Normally these two spaces are completely separated with the development of the diaphragm. Defects in diaphragm morphogenesis may result in congenital diaphragmatic hernias, which is the most known form of communication between the pleural and peritoneal cavity. However, in several cases, findings of pleuroperitoneal communication (PPC) have been described in adults through an apparently intact diaphragm. In this comprehensive review we systematically evaluate clinical scenarios of this form of "unexpected" PPC as reported in the literature and focus on the possible mechanisms involved.

Minimally invasive surgery for pleuroperitoneal communication complicating peritoneal dialysis.

Pleuroperitoneal communication (PPC) is an uncommon but serious complication of continuous ambulatory peritoneal dialysis (CAPD). At present, there are many kinds of treatment options, with different effects. We describe our single-institutional experiences in the minimally invasive surgery of pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis in detail. Our study consecutively enrolled 12 pleuroperitoneal communication patients complicating CAPD. All patients underwent direct closure of the defective diaphragm and mechanical rub pleurodesis under video-assisted thoracoscopy. What is more, pseudomonas aeruginosa injection was infused into the thoracic cavity postoperatively to further promote pleural adhesion, which was the innovation of our study. After 1.0-8.3months of CAPD, all 12 patients presented hydrothorax in the right side. All these patients received surgery 7-179days (18.0 ± 49.5days) after onset. Bleb-like lesions situated on the diaphragm were discovered in all patients and three patients also had obvious hole on the surface of diaphragm. Pseudomonas aeruginosa injection was infused into the thoracic cavity postoperatively, and three cases showed fever with remission after 2-3days of symptomatic treatment. The time from surgery to restarting CAPD ranged from 14 to 47days, with a median of 20days. There was no recurrence of hydrothorax and transformation to hemodialysis during the follow-up period (median: 7.5months). Video-assisted thoracoscopic direct closure of the defective diaphragm and mechanical rub pleurodesis plus chemical pleurodesis using pseudomonas aeruginosa injection postoperatively is a safe and effective option for the treatment of pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis with 100% success rate.

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

BackgroundPleuroperitoneal communication (PPC) is a rare complication of continuous ambulatory peritoneal dialysis (CAPD) and often forces patients to switch to hemodialysis. Some efficiencies of video-assisted thoracic surgery (VATS) for PPC have been reported recently; however, there is no standard approach for these complications. In this case series, we present a combined thoracoscopic and laparoscopic approach for PPC in four patients to better assess its feasibility and efficiency.Case presentationClinical characteristics, perioperative findings, surgical procedures, and clinical outcomes were retrospectively analyzed. We combined VATS with a laparoscopic approach to detect and repair the diaphragmatic lesions responsible for PPC. We first performed pneumoperitoneum in all patients following thoracoscopic exploration. In two cases, we found bubbles gushing out of a small pore in the central tendon of the diaphragm. The lesions were closed with 4-0 non-absorbable monofilament sutures, covered with a sheet of absorbable polyglycolic acid (PGA) felt, and sprayed with fibrin glue. In the other two cases without bubbles, a laparoscope was inserted, and we observed the diaphragm from the abdominal side. In one of the two cases, two pores were detected on the abdominal side. The lesions were closed using sutures and reinforced using the same procedure. In one case, we failed to detect a pore using VATS combined with the laparoscopic approach. Therefore, we covered the diaphragm with only a sheet of PGA felt and fibrin glue. There was no recurrence of PPC, and CAPD was resumed at an average of 11.3 days.ConclusionsThe combined thoracoscopic and laparoscopic approach is an effective treatment for detecting and repairing the lesions responsible for PPC.

Clinical Impact of SPECT/CT in Evaluation of Abdominothoracic Fistula.

Abdominothoracic fistula is rarely observed but can be life-threatening. Pleuroperitoneal communication, known to occur in 1.6% of all patients who undergo continuous ambulatory peritoneal dialysis, is an uncommon but well-recognized complication. The most common symptoms are dyspnea and right-sided pleural effusion. A biliopleural fistula is well-described as a complication of radiofrequency ablation and transcatheter arterial chemoembolization of hepatic lesions. It is important to diagnose the cause of pleural effusion early for proper treatment because if the abdominothoracic fistula effusion amount is not large, appropriate diagnosis may be difficult. Here, we introduce 2 cases showing the usefulness of SPECT/CT in evaluating pleuroperitoneal and biliopleural fistulas.

A sweet unilateral pleural effusion: pleuro-peritoneal communication in a patient on dialysis

A 79-year-old woman was referred to our department with a sudden onset of dyspnoea. She had end-stage kidney disease secondary to IgA nephropathy and, 6 months earlier, had started peritoneal dialysis. The patient did not report a cough, fever, or chills.

A new technique to detect communication sites for pleuroperitoneal communication.

Pleuroperitoneal communication is one of the complications for continuous ambulatory peritoneal dialysis. Communication sites, such as defects or bleb-like lesions, are found in the diaphragm, but it is sometimes difficult to detect these sites. We combined the infrared thoracoscopy and negative pressure technique to detect communication sites. We think our new technique will become an alternative option for difficult and complex cases.

POS-679 SWEET HYDROTHORAX: A PERITONEAL DIALYSIS DILEMMA

Hydrothorax is a rare and serious complication in the patient treated with peritoneal dialysis (PD). It consists of pleuro peritoneal communication through the porous diaphragmatic leak. Its diagnosis is challenging as it may be wrongly considered as fluid overload. It may lead to vicious circle because hypertonic glucose peritoneal solutions may be used thus aggravating surcharge. case report A 45-year-old male with end stage chronic kidney disease secondary to IgA nephropathy, 4 years after starting automated peritoneal dialysis (APD) contacted our institution’s PD unit with complaints of cough and dyspnoea. He has past medical history of hypertension, 2 episodes of peritonitis successfully treated.Clinical examination revealed oedema of the lower extremities and reduced auscultation sounds in the right lower lung. Residual diuresis was absent. Chest radiography confirmed right pleural effusion.Thorax computed tomography showed a massive pleural effusion with right lower-lobe atelectasis and evidence of multiple defects in the diaphragmatic dome with a diaphragm that is shriveled at the right cardiophrenic angle. The thoracentesis drained 1.7L of pleural fluid during the following days.Laboratory findings demonstrated a transudative effusion with the chemical component of pleural fluid similar to PD fluid.We did not find any sign of peritonitis, hypoalbuminaemia, infectious or neoplastic diseases. However, echocardiography revealed cardiac failure. Patient was switched to hemodialysis and intensive ultrafiltration was performed. This case describes an unusual presentation of hydrothorax in the context of peritoneal dialysis. Switchto hemodialysis is frequently necessary temporarily or definitively. All clinicians prescribing peritoneal dialysis should be aware of this complication to avoid delayed diagnosis.

POS-671 PATIENTS WITH POLYCYSTIC KIDNEY DISEASE ON PERITONEAL DIALYSIS: A SINGLE CENTRE TERTIARY CARE RENAL UNIT EXPERIENCE FROM UNITED KINGDOM

Autosomal dominant polycystic kidney disease is the commonest hereditary cause of chronic kidney disease. The reduction of intra-abdominal volume for peritoneal dialysis (PD) due to the enlarging polycystic kidneys and other cystic organs, and the higher risk of complications such as abdominal and inguinal hernias, pericatheter leaks, intestinal perforations, hydrothorax due to pleuro-peritoneal communication, diverticular disease and gastrointestinal reflux raise the concerns about PD catheter insertions, survival, and outcome.

Optimal visualization using indocyanine green fluorescence imaging for pleuroperitoneal communication complicated by CAPD

Optimal visualization using indocyanine green fluorescence imaging for pleuroperitoneal communication complicated by CAPD

Laparoscopic approach for surgical treatment of pleuroperitoneal communication interfering with peritoneal dialysis: a case report

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.

Successful endoscopic surgical treatment of pleuroperitoneal communication in two infant cases

BackgroundPleuroperitoneal communication (PPC) is an uncommon, but potentially life-threatening complication of peritoneal dialysis (PD). If a fistula does not close with conservative treatment, surgical repair is required. However, approximately half of these patients are forced to shift from PD to hemodialysis. Although it is important to confirm the site of the fistula to achieve a successful surgical treatment, this identification is more difficult in pediatric patients than in adults.Case presentationWe report two infantile cases of severe PPC associated with PD. In both cases, the age at onset was less than 2 years, and right-sided pleural effusion with dyspnea was observed. PPC was diagnosed by the change in color of the pleural fluid after the injection of a dye into the peritoneal cavity. Peritoneal scintigraphy and single-photon emission computed tomography and computed tomography (SPECT/CT) were performed, and these were effective in locating the fistula site. Endoscopic surgery (video-assisted thoracic surgery (VATS) and laparoscopic surgery) was performed. Indocyanine green (ICG), which was injected into the abdominal cavity, showed the exact site of the fistula. The fistula was successfully closed by attaching an absorbable sheet to it from the thoracic side and an autograft (the falciform ligament) to it from the abdominal side in one patient. In the other patient, the fistula site was resected and sutured, and reinforced with an absorbable sheet. In both cases, PD was resumed without any complication.ConclusionWe successfully treated two infants of PPC by endoscopic surgery. To identify the fistula site, the ICG navigation method was useful. Even in small infants, PPC can be treated successfully by endoscopic surgical repair if the site of the fistula is identified.

Onset of pleuroperitoneal communication detected by remote patient monitoring

Onset of pleuroperitoneal communication detected by remote patient monitoring

Ectopic endometrial tissue in a diaphragmatic fistula; A case report of pleuroperitoneal communication treated with thoracoscopic surgery

Ectopic endometrial tissue in a diaphragmatic fistula; A case report of pleuroperitoneal communication treated with thoracoscopic surgery

A case of pleuroperitoneal communication in which establishing a laparoscopic pneumoperitoneum was useful for the detection of a fistula

BackgroundPleuroperitoneal communication (PPC) is rarely observed, accounting for 1.6% of all patients who undergo continuous ambulatory peritoneal dialysis (CAPD). Although there have been several reports concerning the management of this condition, we have encountered several cases in which control failed. We herein report a valuable case of PPC in which laparoscopic pneumoperitoneum with video-assisted thoracic surgery (VATS) was useful for supporting the diagnosis and treatment.Case presentationThe patient was a 58-year-old woman with chronic renal failure due to chronic renal inflammation who was referred to a nephrologist in our hospital to undergo an operation for the induction of CAPD. Post-operatively, she had respiratory failure, and chest X-ray and computed tomography (CT) showed right-sided hydrothorax that decreased when the injection of peritoneal dialysate was interrupted. Therefore, PPC was suspected, and she was referred to our department for surgical repair. We planned surgical treatment via video-assisted thoracic surgery. During the surgery, we failed to detect any lesions with thoracoscopy alone; we therefore added a laparoscopic port at her right-sided abdomen near the navel and infused CO2 gas into the abdominal cavity. On thoracoscopy, bubbles were observed emanating from a small pore at the central tendon of the diaphragm, which was considered to be the lesion responsible for the PPC. We closed it by suturing directly.ConclusionsVATS with laparoscopic pneumoperitoneum should be considered as an effective method for inspecting tiny pores of the diaphragm, especially when the lesions responsible for PPC are difficult to detect.

Pleuroperitoneal communication after bacterial peritonitis and total gastrectomy for gastric neuroendocrine tumors: a case report and brief literature review

BackgroundPeritoneal dialysis (PD) is associated with various complications, some of which may result in its discontinuation. Pleuroperitoneal communication (PPC) is commonly recognized by the presence of a diaphragmatic defect and pressure elevation in the abdominal cavity due to the dialysate. PPC is unpredictable and its presence prevents the continuation of PD. We present the clinical course and pathological findings of PPC in a PD patient after bacterial peritonitis and total gastrectomy for gastric neuroendocrine tumors. We provide a brief review of PD-related complications that develop due to a non-infectious pathology, including those related to catheter use and an elevated intra-abdominal pressure.Case presentationA 65-year-old Japanese man, who had been receiving PD treatment for 1 year, visited our hospital owing to a cloudy dialysate. Bacteria were detected in the dialysate. He had been previously diagnosed with gastric neuroendocrine tumors and gastrectomy had been planned. On admission, we started a 14-day antibiotic treatment for PD-related peritonitis. The patient showed a good clinical course. Gastrectomy was performed as planned, and the postoperative course was uneventful. During the perioperative period, PD was temporally changed to hemodialysis. Five weeks after the gastrectomy, PD treatment was resumed with gradual increase in the exchange volume. After returning to PD overnight, using an automated peritoneal dialysis machine, the patient complained of breathing difficulty and he gained weight. Right-sided pleural effusion was observed on a chest radiograph, and PPC was confirmed by scintigraphy when a mixture of technetium-99m and dialysate was seen entering the right hemithorax within 120 min. The patient did not consent to surgery for the PPC and he hoped to continue to receive PD treatment conservatively. We advised the patient to undergo dialysate exchange in a semi-seated position, and he was prohibited from lying down during the daytime. He continued PD treatment without signs of pleural effusion and over-volume.ConclusionsThis case of PPC occurring after bacterial peritonitis and total gastrectomy for gastric neuroendocrine tumors in a PD patient demonstrates the necessity of recognizing the PPC pathology in PD management and establishing methods for preventing PPC development after bacterial peritonitis or surgical procedures.

A case of pleuroperitoneal communication caused by ascites due to portal vein thrombosis successfully treated by video-assisted thoracoscopic surgery (VATS) using a stapler with polyglycolic acid (PGA) sheet

A case of pleuroperitoneal communication caused by ascites due to portal vein thrombosis successfully treated by video-assisted thoracoscopic surgery (VATS) using a stapler with polyglycolic acid (PGA) sheet