Case report: the thoracoscopic surgery in peritoneal-pleural leakage. A valid therapeutic strategy.
G Ital Nefrol
; 37(4)2020 Aug 11.
Article
in En
| MEDLINE
| ID: mdl-32809283
ABSTRACT
Pleuro-peritoneal leakage is an uncommon complication of peritoneal dialysis (PD). In this study, we report the case of a male patient (age 83), treated with PD (daytime single-exchange). In October 2019, hospitalization was necessary due to dyspnoea and a reduction of peritoneal ultrafiltration. A right pleural leakage resulted at chest x-ray. A regression of the pleural leakage was immediately observed after interrupting PD. It was then performed a pleuro-peritoneal CT scan at baseline, followed by a second scan performed 4 hours after the injection of 2 L of isotonic solution with 100ml of contrast medium, which evidenced a pleuro-peritoneal communication. It was then decided to perform a video-assisted thoracoscopic surgery (VATS), that showed no evidence of diaphragm communication. It was then executed a pleurodesis using sterile talcum. The patient was released on the 3rd day, with a conservative therapy and a low-protein diet. After 2 weeks a new pleuro-peritoneal CT scan with contrast medium was executed. This time the scan evidenced the absence of contrast medium in the thoracic cavity. The patient then resumed PD therapy, with 3 daily exchanges with isotonic solution (volume 1.5 L), showing no complications. Concerning the treatment of pleuro-peritoneal leakage, VATS allows both the patch-repairing of diaphragmatic flaws and the instillation of chemical agents. In our case, VATS allowed the chemical pleurodesis which in turn enabled, in just 2 weeks of conservative treatment, the resuming of PD. In conclusion, this methodology is a valid option in the treatment of pleuro-peritoneal leakage in PD patients.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Peritoneal Diseases
/
Pleural Diseases
/
Digestive System Fistula
/
Respiratory Tract Fistula
/
Peritoneal Dialysis
/
Thoracic Surgery, Video-Assisted
Type of study:
Etiology_studies
Limits:
Aged80
/
Humans
/
Male
Language:
En
Journal:
G Ital Nefrol
Journal subject:
NEFROLOGIA
Year:
2020
Document type:
Article
Affiliation country:
Italy