1
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Hashimoto T, Osaki T, Oka S, Fujikawa T. Thoracoscopic and laparoscopic approach for pleuroperitoneal communication under peritoneal dialysis: a report of four cases. Surg Case Rep 2023; 9:55. [PMID: 37029287 PMCID: PMC10082140 DOI: 10.1186/s40792-023-01635-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Pleuroperitoneal 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 PRESENTATION Clinical 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. CONCLUSIONS The combined thoracoscopic and laparoscopic approach is an effective treatment for detecting and repairing the lesions responsible for PPC.
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Affiliation(s)
- Teppei Hashimoto
- Department of Thoracic Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka, 802-8555, Japan.
| | - Toshihiro Osaki
- Department of Thoracic Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka, 802-8555, Japan
| | - Soichi Oka
- Department of Thoracic Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka, 802-8555, Japan
| | - Takahisa Fujikawa
- Department of Gastroenterological Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka, 802-8555, Japan
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2
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Tsubouchi H, Nakamura S, Fukui T, Kadomatsu Y, Ueno H, Ozeki N, Fukumoto K, Mizuno M, Chen-Yoshikawa TF. Video-assisted thoracoscopic surgery for pleuroperitoneal communication. Asian J Endosc Surg 2022; 16:262-265. [PMID: 36114644 DOI: 10.1111/ases.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
Here we report the cases of five patients on continuous ambulatory peritoneal dialysis (CAPD) who developed hydrothorax because of pleuroperitoneal communication. Preoperative computed tomography (CT) peritoneography revealed penetrated sites on the diaphragm in all patients. All patients underwent video-assisted thoracoscopic surgery (VATS), and a dialysate containing indigo carmine was injected intraperitoneally through a CAPD catheter to confirm the fistula. In all patients, a thinned bleb was found at the center of the diaphragmatic tendon consistent with that noted on preoperative CT peritoneography. The bleb was resected using a surgical stapler in four patients, and the pleuroperitoneal communication did not recur. However, in one patient, the bleb was only covered with reinforcement agents and the hydrothorax recurred after CAPD. This study demonstrates that VATS treatment for pleuroperitoneal communication is safe and effective but that lesion resection would be more useful for preventing hydrothorax recurrence in patients undergoing CAPD.
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Affiliation(s)
- Hideki Tsubouchi
- Department of Thoracic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Fukui
- Division of Chest Surgery, Aichi Medical University, Nagakute, Japan
| | - Yuka Kadomatsu
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Harushi Ueno
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koichi Fukumoto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Mizuno
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
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3
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The new method to make diagnosis and identify the location of leakage of pleuroperitoneal communication in peritoneal dialysis patients. CEN Case Rep 2022; 11:471-476. [DOI: 10.1007/s13730-022-00701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
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4
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Kou Y, Yamazaki N, Sakaguchi Y, Tanaka H, Sonobe M. A new technique to detect communication sites for pleuroperitoneal communication. Gen Thorac Cardiovasc Surg 2022; 70:591-592. [PMID: 35113316 DOI: 10.1007/s11748-022-01777-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Yuuki Kou
- Department of Thoracic Surgery, Japanese Red Cross Osaka Hospital, Fudegasaki-cho 5-30, Tennnouji-ku, Osaka, 543-8555, Japan.
| | - Nobuhisa Yamazaki
- Department of Thoracic Surgery, Japanese Red Cross Osaka Hospital, Fudegasaki-cho 5-30, Tennnouji-ku, Osaka, 543-8555, Japan
| | - Yasuto Sakaguchi
- Department of Thoracic Surgery, Japanese Red Cross Osaka Hospital, Fudegasaki-cho 5-30, Tennnouji-ku, Osaka, 543-8555, Japan
| | - Hirokazu Tanaka
- Department of Thoracic Surgery, Japanese Red Cross Osaka Hospital, Fudegasaki-cho 5-30, Tennnouji-ku, Osaka, 543-8555, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Japanese Red Cross Osaka Hospital, Fudegasaki-cho 5-30, Tennnouji-ku, Osaka, 543-8555, Japan
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5
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Yorinaga S, Maki T, Kawai N, Kaneko H, Misu K, Inomata H, Omi M, Hirano S. Laparoscopic approach for surgical treatment of pleuroperitoneal communication interfering with peritoneal dialysis: a case report. Surg Case Rep 2021; 7:217. [PMID: 34580781 PMCID: PMC8476674 DOI: 10.1186/s40792-021-01228-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Pleuroperitoneal 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 presentation We 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. Conclusion 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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Affiliation(s)
- Satoko Yorinaga
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Japan.
| | - Takehiro Maki
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Noriko Kawai
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Hiroyuki Kaneko
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Kenjiro Misu
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Hitoshi Inomata
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Makoto Omi
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Hospital, Sapporo, Japan
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6
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Mori T, Fujino A, Takahashi M, Furugane R, Kobayashi T, Kano M, Yoneda A, Kanamori Y, Suzuki R, Nishi K, Kamei K, Kitamura M. Successful endoscopic surgical treatment of pleuroperitoneal communication in two infant cases. Surg Case Rep 2021; 7:181. [PMID: 34383172 PMCID: PMC8360259 DOI: 10.1186/s40792-021-01266-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Pleuroperitoneal 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 presentation We 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. Conclusion We 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.
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Affiliation(s)
- Teizaburo Mori
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Akihiro Fujino
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masataka Takahashi
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Ryoya Furugane
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Tamotsu Kobayashi
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Motohiro Kano
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Akihiro Yoneda
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Yutaka Kanamori
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Ryutaro Suzuki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masayuki Kitamura
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
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Tatematsu S, Hosoya K, Ryuzaki M. Successful treatment of pleuroperitoneal communication with pleurodesis using autologous blood in a patient with severe heart failure undergoing peritoneal dialysis: a case report and brief literature review. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00273-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pleuroperitoneal communication is a potential complication of peritoneal dialysis (PD). Of the various treatment strategies for pleuroperitoneal communication, successful treatment with pleurodesis using autologous blood has rarely been reported.
Case presentation
A 58-year-old man with end-stage kidney disease secondary to diabetic nephropathy and severe heart failure was placed on PD. He developed right-sided hydrothorax after the commencement of PD. Technetium-99m macro-aggregated human serum albumin peritoneal scintigraphy revealed pleuroperitoneal communication. PD was temporarily discontinued and substituted with hemodialysis. Subsequently, the levels of pleural fluid decreased. However, the resumption of PD exacerbated the hydrothorax. After thoracentesis, 50 mL of autologous blood was instilled into the right pleural cavity. There were no complications related to the procedure. PD was reinitiated 5 days after pleurodesis. Repeated chest X-rays did not depict any evidence of recurrent hydrothorax over the subsequent 10 months.
Conclusions
Pleurodesis using autologous blood was effective for pleuroperitoneal communication and was evidently safe in our patient. It should be considered in patients with severe heart failure since it is minimally invasive.
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Affiliation(s)
- R. Garcia Ramon
- Peritoneal Dialysis Unit Nephrology Department Hospital Clínico Universitario Valencia, Spain
| | - A. Miguel Carrasco
- Peritoneal Dialysis Unit Nephrology Department Hospital Clínico Universitario Valencia, Spain
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9
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Fang S, Wu Z, Wang Q, Peng X, Zhan T, Wu M. Thoracoscopic surgery for management of pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis: A case report. Medicine (Baltimore) 2019; 98:e15391. [PMID: 31083167 PMCID: PMC6531203 DOI: 10.1097/md.0000000000015391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Pleuroperitoneal communication (PPC) has been reported to complicate continuous ambulatory peritoneal dialysis (CAPD). However, cases of patients in whom the results of the methylene blue dye test and peritoneopleural scintigraphy were negative and treatment was thoracoscopic surgery have been rarely reported. PATIENT CONCERNS A 58-year-old man with end-stage chronic renal failure who underwent CAPD presented with massive right-sided hydrothorax. The pleural fluid glucose level was high. Results of both the methylene blue dye test and peritoneopleural scintigraphy were negative. DIAGNOSIS The presence of end-stage chronic renal failure and diaphragm defects amenable to repair, which were identified during thoracoscopic surgery, indicated a definite diagnosis of PPC complicating CAPD. INTERVENTIONS AND OUTCOMES CAPD was performed twice after the defects were repaired during thoracoscopic surgery. There was no evidence that the repaired sites were leaking again, and the patient did not complain of any discomfort during the second CAPD. LESSON Although special methods such as the methylene blue dye test and peritoneopleural scintigraphy may not be useful in some cases, thoracoscopic surgery is still effective and reliable in diagnosing and repairing diaphragmatic defects.
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Affiliation(s)
- Shuai Fang
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Zixiang Wu
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Qi Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Xuyang Peng
- Department of Thoracic Surgery, the People's Hospital of Lishui, Lishui, China
| | - Tianwei Zhan
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Ming Wu
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
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10
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Mitsuboshi S, Maeda H, Kanzaki M. Video-assisted thoracic surgery for pleuroperitoneal communication. Surg Case Rep 2019; 5:34. [PMID: 30783792 PMCID: PMC6381193 DOI: 10.1186/s40792-019-0595-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hydrothorax due to pleuroperitoneal communication (PPC) is a rare complication of continuous ambulatory peritoneal dialysis (CAPD). Approximately 50% of the patients need to convert to hemodialysis. Case presentation A 65-year-old man with chronic renal failure due to membranoproliferative glomerulonephritis underwent CAPD. Seven months after starting CAPD, a chest X-ray showed a right hydrothorax. For performing radioscintigraphy, 99mTc-macro-aggregated albumin was administered into the peritoneal cavity with dialysate, and a leakage point of the dialysate into the right pleural cavity was detected. He was diagnosed with PPC and underwent video-assisted thoracic surgery (VATS). The hole was closed by direct suturing and reinforced by a pedicled latissimus dorsi muscle flap (LDM). The patient resumed CAPD 7 weeks later and had no recurrence of the right hydrothorax. Conclusions VATS was a useful method for treating PPC. A pedicled LDM flap is an effective material for preventing the recurrence of PPC.
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Affiliation(s)
- Shota Mitsuboshi
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hideyuki Maeda
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Masato Kanzaki
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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11
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Al-Zoubi RK, Abu Ghanimeh M, Gohar A, Salzman GA, Yousef O. Hepatic hydrothorax: clinical review and update on consensus guidelines. Hosp Pract (1995) 2016; 44:213-223. [PMID: 27580053 DOI: 10.1080/21548331.2016.1227685] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatic Hydrothorax (HH) is defined as a pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. It is an uncommon complication of cirrhosis, most frequently seen in association with decompensated liver disease. The development of HH remains incompletely understood and involves a complex pathophysiological process with the most acceptable explanation being the passage of the ascetic fluid through small diaphragmatic defects. Given the limited capacity of the pleural space, even the modest pleural effusion can result in significant respiratory symptoms. The diagnosis of HH should be suspected in any patient with established cirrhosis and portal hypertension presenting with unilateral pleural effusion especially on the right side. Diagnostic thoracentesis should be performed in all patients with suspected HH to confirm the diagnosis and rule out infection and alternative diagnoses. Spontaneous bacterial empyema and spontaneous bacterial pleuritis can complicate HH and increase morbidity and mortality. HH can be difficult to treat and in our review below we will list the therapeutic modalities awaiting the evaluation for the only definitive therapy, which is liver transplantation.
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Affiliation(s)
- Rana Khazar Al-Zoubi
- a School of Medicine Ringgold standard institution - Pulmonary & Critical Care , University of Missouri Kansas City School of Medicine , Kansas City , MO , USA
| | - Mouhanna Abu Ghanimeh
- b School of Medicine Ringgold standard institution - Internal Medicine , University of Missouri Kansas City School of Medicine , Kansas City , MO , USA
| | - Ashraf Gohar
- c School of Medicine - Pulmonary and Critical Care Medicine , University of Missouri-Kansas City School of Medicine , Kansas City , MO , USA
| | - Gary A Salzman
- c School of Medicine - Pulmonary and Critical Care Medicine , University of Missouri-Kansas City School of Medicine , Kansas City , MO , USA
| | - Osama Yousef
- d School of Medicine - Gastroenterology Medicine , University of Missouri-Kansas City School of Medicine , Kansas City , MO , USA
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12
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Ratajczak A, Lange-Ratajczak M, Bobkiewicz A, Studniarek A. Surgical Management of Complications with Peritoneal Dialysis. Semin Dial 2016; 30:63-68. [PMID: 27596540 DOI: 10.1111/sdi.12538] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This report reviews the most common surgical interventions and complications of chronic peritoneal dialysis (PD) patients. Based on the current knowledge as well as our experience we detail the role of these surgical procedures. We supplement the reported knowledge in the field with our own experience in this area. The areas discussed include early complications such as surgical wound hemorrhage, bleeding from the catheter, intestinal perforation and urinary bladder perforation, dialysate leakage through the wound, as well as late complications including catheter kinking or occlusion, retention of fluid in the peritoneal recess, hernias and hydrothorax, and encapsulating peritoneal sclerosis. We also briefly cover the surgical aspects of exit-site infection and peritonitis. An understanding by nephrologists of the role for surgical intervention in PD patients will improve their care and outcomes.
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Affiliation(s)
- Andrzej Ratajczak
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Lange-Ratajczak
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adam Bobkiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adam Studniarek
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
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13
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Saito M, Nakagawa T, Tokunaga Y, Kondo T. Thoracoscopic surgical treatment for pleuroperitoneal communication. Interact Cardiovasc Thorac Surg 2012; 15:788-9. [PMID: 22753435 DOI: 10.1093/icvts/ivs193] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Hydrothorax as a result of pleuroperitoneal communication (PPC) is an uncommon but a well-known complication of continuous ambulatory peritoneal dialysis (CAPD). In this paper, we present a 60-year old man with diabetic renal failure who underwent CAPD. Two weeks after starting CAPD, chest radiographs showed a right-sided hydrothorax. Radioscintigraphy was performed and PPC was diagnosed. Eight days after the diagnosis, thoracoscopic surgery was performed. The leakage points were closed by direct suturing with absorbable polyglycolic acid felt and fibrin glue. The patient resumed CAPD 2 weeks later, and there was no recurrence of the right hydrothorax. Video-assisted thoracic surgery with direct suturing represents a feasible method for treating PPC with confirmed fistulae.
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Affiliation(s)
- Masao Saito
- Department of Thoracic Surgery, Tenri Hospital, Nara, Japan.
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14
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Tapawan K, Chen E, Selk N, Hong E, Virmani S, Balk R. A Large Pleural Effusion in a Patient Receiving Peritoneal Dialysis. Semin Dial 2011; 24:560-3. [DOI: 10.1111/j.1525-139x.2011.00859.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Abstract
Hydrothorax in a patient treated with peritoneal dialysis (PD) poses a diagnostic dilemma. Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of PD but generally does not threaten life. Shortness of breath causes the patient to seek medical attention. A sudden diminution in dialysis adequacy or poor ultrafiltration rate constitutes a unique marker for patients treated with PD compared to the general population. This article reviews the etiology for hydrothorax specifically in the PD population. Thoracentesis with chemical analysis of the fluid, imaging studies with and without contrast or markers, and video-assisted thoracoscopic surgery play important roles in the evaluation of hydrothorax. A conservative PD regimen, surgical intervention, and pleurodesis provide treatment options to those receiving PD.
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Affiliation(s)
- Susie Q Lew
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC 20037, USA.
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16
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Kang TW, Kim CK. Pleuroperitoneal communication of peritoneal dialysis demonstrated by multidetector-row CT peritoneography. ACTA ACUST UNITED AC 2008; 34:780-2. [PMID: 18972150 DOI: 10.1007/s00261-008-9468-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 09/26/2008] [Indexed: 11/29/2022]
Abstract
Hydrothorax as a result of pleuroperitoneal communication is an uncommon complication in continuous ambulatory peritoneal dialysis (CAPD) patients. CT peritoneography is a useful method for evaluating a wide variety of complications due to CAPD. We report a case of pleuroperitoneal communication with specific imaging features on multidetector-row CT peritoneography (MDCT).
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Affiliation(s)
- Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, SungKyunKwan University, School of Medicine, Seoul, Republic of Korea
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17
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Abstract
Hydrothorax as a result of pleuroperitoneal communication occurs in approximately 2% of continuous ambulatory peritoneal dialysis (CAPD) patients. Although our understanding of its mechanisms is incomplete, it is apparent that the key to successful therapy is obliteration of a transdiaphragmatic route of dialysate leakage (pleuroperitoneal communication), possibly coupled with reduction of intra-abdominal pressure. This review corroborated the findings from 10 major population-based case series in which 60 of the 104 cases (58%) were able to resume long-term peritoneal dialysis (PD). Temporary interruption of PD alone was successful in half of them. As compared to this conservative approach, as well as chemical pleurodesis via intercostal chest drain, video-assisted thoracoscopic intervention (including direct pleurodesis and diaphragmatic repair) has shown a promising role. Efficacy of thoracoscopic treatment has been confirmed by several case series from various centers and the demonstration of a success rate in excess of 90%. With accumulating experience using the thoracoscopic technique, it remains to be seen whether this mode of treatment will obviate the traditional closed pleurodesis.
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Affiliation(s)
- Kai Ming Chow
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Tang S, Chui WH, Tang AWC, Li FK, Chau WS, Ho YW, Chan TM, Lai KN. Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis. Nephrol Dial Transplant 2003; 18:804-8. [PMID: 12637652 DOI: 10.1093/ndt/gfg042] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acute, massive, unilateral hydrothorax is an uncommon but well-recognized complication of peritoneal dialysis. Its clinical course and treatment outcome after a recently advocated technique of video-assisted thoracoscopic (VATS) talc pleurodesis remains unclear. METHODS AND RESULTS Between July 1998 and March 2002, among 475 CAPD patients in two regional hospitals in Hong Kong, nine patients (three men, six women, mean age 53+/-12 years) developed acute hydrothorax due to pleuroperitoneal communication (R=8, L=1) within 5.8+/-4.2 months (median, 5.2 m; range, 2 days to 11.6 months) of commencing peritoneal dialysis. Analysis of simultaneously obtained peritoneal and pleural fluid in all subjects only showed concordance in protein content (consistently<4 g/l), while fluid glucose and lactate dehydrogenase levels were not comparable. The methylene blue test was negative (n=4). Radionuclide scan (n=6) and contrast CT peritoneography (CTP, n=3) detected pleuroperitoneal communication in half and one-third of the patients, respectively. All patients underwent pleurodesis achieved by talc insufflation into the pleural cavity under VATS guidance. All patients were successfully returned to peritoneal dialysis. After a mean follow-up of 18.8+/-12.5 months, hydrothorax recurred in one patient (at 7 months after pleurodesis), who was successfully treated by repeating the procedure. CONCLUSIONS Hydrothorax complicating CAPD is more commonly right-sided, and tends to occur within the first year of starting peritoneal dialysis. Isotope scan and CTP are insensitive in diagnosing pleuroperitoneal communication. A low pleural fluid protein content is the most consistent biochemical finding. VATS talc pleurodesis is a safe and reliable treatment of choice that allows sustained continuation of CAPD with low recurrence rate.
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Affiliation(s)
- Sydney Tang
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, Peoples' Republic of China
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Halstead JC, Lim E, Ritchie AJ. Acute hydrothorax in CAPD. Eearly thoracoscopic (VATS) intervention allows return to peritoneal dialysis. Nephron Clin Pract 2003; 92:725-7. [PMID: 12372967 DOI: 10.1159/000064101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Hydrothorax is a complication of continuous ambulatory peritoneal dialysis (CAPD) occurring due to pleuroperitoneal fistulae. Several treatments exist with no consensus as to best management. We report on the largest series of video-assisted thoracoscopic surgery (VATS) treated pleuroperitoneal fistulae yet available. METHODS Between 1995 and 2000, we treated 6 CAPD patients for acute right hydrothoraces using VATS. Data pertaining to size and sterility of hydrothoraces, presence of diaphragmatic defects, surgical procedures performed, morbidity and return to CAPD were obtained. RESULTS Hydrothoraces were drained in all patients and there were no significant growths on subsequent culture. Fistulae were directly identified and closed in three patients. In the remaining patients, endoclips were placed across the base of small diaphragmatic blebs (the presumed site of communication). Parietal pleurectomy was performed uneventfully in all patients. There was no morbidity, all patients returned to haemodialysis and there have been no recurrences. CONCLUSIONS Pleuroperitoneal fistulae produce symptomatic hydrothoraces in CAPD patients. A variety of approaches to the problem have been described. This is the largest series of VATS available and shows the usefulness of this approach in both closing the defect and producing an effective pleurectomy to prevent recurrence.
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Affiliation(s)
- J C Halstead
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
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Milanez de Campos JR, Filho LO, de Campos Werebe E, Sette H, Fernandez A, Filomeno LT, Jatene FB. Thoracoscopy and talc poudrage in the management of hepatic hydrothorax. Chest 2000; 118:13-7. [PMID: 10893352 DOI: 10.1378/chest.118.1.13] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVE To determine indications, limitations, morbidity and mortality of surgical thoracoscopy for management of hepatic hydrothorax, a rare, but often recurrent, complication in cirrhotic patients. PATIENTS AND METHODS From May 1985 through May 1999, 10 men and 8 women, with a mean age of 57.6 years (range, 26 to 76 years), underwent 21 therapeutic thoracoscopies to achieve pleurodesis by application of talc. RESULTS The procedure was effective in 10 of 21 procedures. There were four recurrences (19. 1%) that were retreated, with only one being successful. In this specific group, we detected high morbidity (57.1%) and mortality (38.9%) during the follow-up period of 3 months. Diaphragmatic defects were localized and closed five times (23.8%). Hospital stay was approximately 15 days (range, 5 to 41 days). CONCLUSION The procedure appears to be indicated for these fragile patients, especially when medical therapy fails. Immediate efficacy was 47.6%, increasing to 60% with videothoracoscopy and suture of the diaphragmatic defect. However, morbidity and mortality were high.
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Affiliation(s)
- J R Milanez de Campos
- Division of Thoracic Surgery, Hospital Israelita Albert Einstein and Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil.
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Okada H, Ryuzaki M, Kotaki S, Nakamoto H, Sugahara S, Kaneko K, Yamamoto T, Kawahara H, Suzuki H. Thoracoscopic surgery and pleurodesis for pleuroperitoneal communication in patients on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 1999; 34:170-2. [PMID: 10401034 DOI: 10.1016/s0272-6386(99)70126-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two patients on continuous ambulatory peritoneal dialysis (CAPD) developed right massive hydrothorax and were diagnosed as having pleuroperitoneal communication. Thoracoscopic surgery and pleurodesis were performed. It showed that one was caused by multiple flaws in the diaphragm and that the other was attributable to multiple blebs in the diaphragmatic dome. After the procedure, both of them had no recurrence of hydrothorax and underwent CAPD safely. We recommend thoracoscopic surgery and pleurodesis as the first choice of therapeutic methods for pleuroperitoneal communication.
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Affiliation(s)
- H Okada
- Department of Nephrology, Saitama Medical College, Irumagun, Japan.
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Abstract
Hepatic hydrothorax occurs frequently in ascites arising from communications in the diaphragm between peritoneal and pleural cavities. Numerous treatments have been described but are of limited utility due to invasiveness and poor success rate. We describe a case of hepatic hydrothorax in which the pore in the diaphragm was documented photographically and in which successful resolution was achieved with videothoracoscopic suture ligation and talc pleurodesis.
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Affiliation(s)
- R T Temes
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, USA.
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