Pleuroperitoneal Leak Research Articles

Bilateral Pleural Effusion in Continuous Ambulatory Peritoneal Dialysis Managed by Vats Pleurodesis.

Recurrent dyspnoea in a chronic peritoneal dialysis patient should raise the diagnosis of a possible pleuroperitoneal leak, even if no apparent loss of ultrafiltration was observed.Minimally invasive surgical pleurodesis using surgical adhesive can be considered in cases of refractory pleuroperitoneal leak.

Hydrothorax with Atypical Features as a Complication of Peritoneal Dialysis: A Case Report and Literature Review

Hydrothorax is an uncommon but established complication of peritoneal dialysis, usually arising from pleuroperitoneal leak. There is currently no consensus on definitive testing or management. Thoracentesis, sclerosing agents, and either temporary or permanent discontinuation of peritoneal dialysis in favor of hemodialysis are often considered. We report an unusual case of right-sided PD-associated hydrothorax in a 54-year-old female with a history of hypertension and anemia, who presented without chest pain or dyspnea but rather with fatigue and syncope. We review the current literature on this etiology regarding underlying causes, as well as best practices for diagnosis and treatment.

Respiratory distress associated with acute hydrothorax during transurethral electrocoagulation: a case report

BackgroundIn patients undergoing abdominal radiotherapy or transurethral surgery, bladder perforations are a possible complication. Likewise, pleural effusions due to a pleuroperitoneal leak caused by either a congenital or acquired diaphragmatic defect can also occur. We report a case in which a saline solution, which migrated into the abdominal cavity from a bladder perforation during transurethral electrocoagulation, further formed bilateral pleural effusions and caused rapid ventilation failure.Case presentationA patient undergoing radiation therapy and hormone therapy for prostate cancer underwent emergency surgery for electrocoagulation due to hematuria and a rapid drop in hemoglobin. The surgery began under general anesthesia, and we first noticed an increase in airway pressure and a decrease in dynamic lung compliance, followed by abdominal distension. Based on readouts from the respiratory mechanics monitor, we suspected lung abnormalities and performed a pulmonary ultrasound, leading to a diagnosis of bilateral pleural effusions, which we then drained.ConclusionsRespiratory mechanics monitoring is simple and can be performed at all times during anesthesia, and when combined with pulmonary ultrasound, diagnoses can be made quickly and prevent deaths.

Recurrent hydrothorax associated with peritoneal dialysis: challenges in the diagnosis of pleuroperitoneal leak

Background: Peritoneal dialysis can be associated with various mechanical complications. Among them, pleuroperitoneal leak leading to recurrent hydrothorax is a lesser known entity. The condition can lead to life-threatening complications like respiratory distress, cardiac failure, arrhythmias, and infections. Various imaging modalities like computerized tomography, magnetic resonance imaging, and nuclear scans have been used to establish the diagnosis of pleuroperitoneal leak. Case Presentation: An elderly gentleman with multiple co-morbidities on peritoneal dialysis presented with recurrent hydrothorax. After ruling out cardiac, infective, and neoplastic etiologies as causes for hydrothorax, the diagnosis of pleuroperitoneal leak was established using computerized tomography peritoneography. Despite temporarily interrupting peritoneal dialysis, our patient developed recurrent hydrothorax, thus requiring to be transferred to hemodialysis. Conclusion: A high index of clinical suspicion and choice of the imaging modality will help in the timely diagnosis of pleuroperitoneal leak and appropriate therapeutic intervention.

Pleuroperitoneal Leak in Peritoneal Dialysis: A Series of 10 Cases

Pleuroperitoneal Leak (PPL) is a rare, but serious complication of Peritoneal Dialysis (PD). It is the result of congenital or acquired communication between the 2 peritoneal and pleural cavities, and is often linked to high Intra-Abdominal Pressures (IAP). Its diagnosis is clinical, radiological and biological. In this article, we report 10 cases of PPL identified over a period of 13 years (2006-2019), that is to say, a prevalence of 5%. We suspected the diagnosis of FPP in front of dyspnea alone in 5 cases (50%), dyspnea associated with cough in 4 cases (40%). Catheter migration was reported in 5 patients (50% of cases). None of our patients presented with peritonitis before FPP. The pleurisy was right in 7 patients (70%). The exploratory puncture of the Pleural Fluid (PF) was performed in 3 patients, and which showed results consistent with the PD fluid. The drop in infusion volumes was required in 4 patients (40%) with an increase in the number of daily exchanges of CAPD with IVs ranges from 1200 - 1500 ml. PD was suspended in 6 patients (60%) for an average of 40 days (21 days - 60 days), 2 withdrawals from the technique were reported after the 2nd recurrence (20%). PD was stopped straight away in 1 patient with a hypo-permeable peritoneum with unsatisfactory residual renal function and a second who freely chose to stay in HD. The clinical cases presented show the great variability of FPP in terms of clinical and radiological presentation and therapeutic management, and focus on the significant risk of a transient or permanent withdrawal from the technique. According to literature data, Video-assisted thoracoscopic surgery appears to be promising in the event of failure of conservative treatment, and will thus prolong the survival of the technique.

Pleuroperitoneal Leak as an Uncommon Cause of Pleural Effusion in Peritoneal Dialysis: A Case Report and Literature Review

Pleural effusions are frequently seen in patients on dialysis. A pleuroperitoneal leak or communication is a rare but important cause of pleural effusion in patients on peritoneal dialysis. This diagnosis can be made with a combination of biochemical tests and radiological modalities, in the absence of a gold standard diagnostic test. In addition to thoracocentesis, treatment often involves cessation of peritoneal dialysis and transition to hemodialysis. We describe a case of an 80-year-old man who presented with unilateral right-sided pleural effusion. He underwent therapeutic thoracocentesis and was subsequently diagnosed with a pleuroperitoneal leak through pleural fluid analysis. Peritoneal dialysis was ceased, and he transitioned temporarily to hemodialysis. He was subsequently treated with talc pleurodesis and successfully recommenced on peritoneal dialysis at six weeks after operation. In our report, we also review diagnostic imaging modalities, as well as advantages and disadvantages of each modality. A pleuroperitoneal leak is a rare but important complication of peritoneal dialysis and needs consideration in any patient on peritoneal dialysis presenting with unilateral pleural effusion.

Confirmation of the pleuroperitoneal leak origin with a SPECT-CT in a patient on peritoneal dialysis

Confirmation of the pleuroperitoneal leak origin with a SPECT-CT in a patient on peritoneal dialysis

Scintigraphic peritoneography in the diagnosis of pleuroperitoneal leak complicating peritoneal dialysis: A comparison with conventional diagnostic methods.

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.

Recurrent pleuroperitoneal leak caused by diaphragm blebs in a peritoneal dialysis patient: a case report with literature review

BackgroundPleuroperitoneal leak is an uncommon but significant complication of peritoneal dialysis. Although the exact pathogenesis of pleuroperitoneal communication remains unclear, the pressure gradient between the thorax and abdominal cavity has been thought to play a major role.Case presentationA 48-year-old man with diabetes mellitus and hypertension who had been treated with continuous ambulatory peritoneal dialysis (1.5 L dwells four times a day) for 3 months was admitted because of massive right-sided pleural effusion. He underwent video-assisted thoracoscopic surgery for blebs on the diaphragm. Six weeks after diaphragmatic repair, he resumed peritoneal dialysis (1.5 L dwells four times a day) with once-a-week hemodialysis. Thereafter, pleural effusion was not significant on a chest radiogram. Six months after surgery, his dwell volume increased from 1500 to 2000 ml, and significant right-sided pleural effusion also developed.ConclusionPleuroperitoneal leak caused by blebs can recur even after surgical treatment, and reducing the dwell volume may be effective for patients with pleuroperitoneal communication.

Pleuro-Peritoneal Fistula – An Important Condition to Consider in Patients using Peritoneal Dialysis

Pleural effusions are a common finding in patients admitted on the medical take. This case decribes a patient using peritoneal dialysis who presented with progressive dyspnoea. Clinical examination and chest x-ray confirmed the presence of a pleural effusion. Thoracocentesis confirmed a ‘sweet’ effusion (higher pleural: serum glucose content), suggesting a pleuro-peritoneal leak. Optimal management involved switch from peritoneal to haemodialysis and referral to a specialised renal unit. This case highlights the need to consider the diagnosis of pleuro-peritoneal leak in patients using peritoneal dialysis who present to the acute medical unit with pleural effusion.

Diagnosis of Peritoneal-pleural Communication by Peritoneography With 99mTc-sulfur Colloid in a 3-year-old Girl With Congenital Nephrotic Syndrome of the Finnish Type

Around 5% of patients receiving renal replacement therapy in Spain are on peritoneal dialysis. Anatomical integrity of the peritoneum is essential since increased hydrostatic pressure due to peritoneal accumulation of dialysis fluid predisposes to abdominal or pelvic hernias or chest leakage via the embryonic pneumatoenteric recess.1 We report the case of a 3-year-old girl with a history of Finnish-type congenital nephrotic syndrome, receiving postnephrectomy peritoneal dialysis since the age of 2. Fourteen months after starting peritoneal dialysis, she was admitted to our hospital due to severe dyspnea, with massive right hydrothorax on chest X-ray. To rule out pleuroperitoneal leak, a peritoneal

Atypical Pleural Effusions in Patients on Peritoneal Dialysis

Rarely, peritoneal dialysis (PD) is complicated by a hydrothorax, often referred to as a pleural effusion, that commonly occurs early after starting PD and is usually right-sided. We illustrate three cases of atypical hydrothorax presenting in PD patients. Case 1 is a 72-year-old lady with left-sided pleuroperitoneal communication confirmed on nuclear imaging. Case 2 is a 50-year-old lady who presented with right-sided pleuroperitoneal leak which occurred 11 months after commencement of PD. The last case is a 64-year-old man with congestive cardiac failure secondary to ischemic heart disease who had recurrent right-sided pleural effusion despite multiple pleural drainage. He continued on PD with no drainage problems. Pleuroperitoneal leaks need to be excluded even in patients presenting with left-sided effusion and in those who present late after commencement of PD. World J Nephrol Urol. 2015;4(4):256-259 doi: http://dx.doi.org/10.14740/wjnu227w

Pleuroperitoneal leak: an unusual cause of acute shortness of breath in a peritoneal dialysis patient.

Introduction. Pleuroperitoneal leak is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD), with an estimated incidence of 1.6%. It should be suspected in these patients when they present with recurrent unilateral pleural effusions and/or acute shortness of breath following dialysate infusion. Case Presentation. We present the case of a 25-year-old female patient who had acute hydrothorax as a result of pleuroperitoneal leak complicating continuous ambulatory peritoneal dialysis (CAPD), which was confirmed on peritoneal scintigraphy. Conclusion. Continuous ambulatory peritoneal dialysis patients presenting with acute shortness of breath and/or recurrent unilateral pleural effusion should be investigated with peritoneal scintigraphy to exclude pleuroperitoneal leak.

Hydrothorax after robotic-assisted surgical staging of endometrial cancer

► Hydrothorax from a pleuroperitoneal leak is a rare complication of laparoscopy. ► First case report of hydrothorax during robot-assisted laparoscopic surgery. ► Consider hydrothorax if new onset respiratory compromise after laparoscopy.

Pleuroperitoneal Leak Complicating Peritoneal Dialysis: A Case Series

Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.

Acute hydrothorax complicating peritoneal dialysis: a case report.

IntroductionAcute hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis. No single test is definitive for diagnosis. Although it is not a life-threatening condition, hydrothorax often requires abandonment of peritoneal dialysis. Delay in diagnosis can lead to worsening of the clinical status.Case PresentationA 33-year-old Caucasian woman with lupus, who was successfully treated with temporary peritoneal dialysis 17 years previously, presented with acute dyspnea and a right pleural effusion after recommencing peritoneal dialysis. Investigations eliminated infective, cardiac, and primary respiratory causes. Peritoneal dialysis-related hydrothorax was suggested by biochemistry, and a pleuroperitoneal leak was definitively confirmed by using a Tc-99 m DTPA (diethylene triamine penta-acetic acid) scintigraphy scan. Subsequently, she underwent video-assisted thoracoscopy-guided talc pleurodesis and was able to return successfully to peritoneal dialysis.ConclusionAlthough our case is not the first report that describes the occurrence of acute hydrothorax in peritoneal dialysis, it is an important condition to recognize for the wider general medical community. Furthermore, this case demonstrates that peritoneal dialysis can be continued with a hydrothorax, provided the underlying cause can be corrected. We review the literature pertaining to the utility and reliability of different diagnostic approaches to hydrothorax.

La gammagrafía con Tc99m intraperitoneal como técnica diagnóstica de fugas diafragmáticas en pacientes en diálisis peritoneal: a propósito de dos casos.

Pleural effusion secondary to pleuroperitoneal communication is an unusual complication of continuous ambulatory peritoneal dialysis. Many modalities have been used to diagnosis pleuroperitoneal: pleural fluid analysis, chest X- ray, Tc-99m gammagraphy, computed tomography scan and magnetic resonance image. Some of these procedures are invasive or have a high risk of induced-contrast nephrotoxicity. We present two case reports of pleuroperitoneal leak in two patients on peritoneal dialysis diagnosed with Tc-99m gammagraphy. We conclude that Tc- 99m gammagraphy is a simple, safe, non invasive, low radiation exposure and cost effective method in the assessment and evaluation of complications related to peritoneal dialysis such as pleuroperitoneal leak.

Hydrothorax in 2 children on CAPD: review of clinical approach and treatment options

Pleural effusions are seen relatively common in end-stage renal disease (ESRD) patients, on the other hand, hydrothorax secondary to pleuroperitoneal leak in continuous ambulatory peritoneal dialysis (CAPD) patients is rare. Since treatment modalities differ widely from that of other causes of pleural effusion seen in CAPD patients such as uremia, volume overload, congestive heart failure, infection and malignancy, pleuroperitoneal leak should always be kept in mind in the differential diagnosis and should be excluded urgently. To draw attention to this point, in this paper, 2 children on CAPD who developed a hydrothorax secondary to a pleuroperitoneal communication are presented with an overview of diagnostic tools and treatment modalities.