Simple surgical treatment for pleuroperitoneal communication without interruption of continuous ambulatory peritoneal dialysis.
Pleuroperitoneal communication is a complication of continuous ambulatory peritoneal dialysis (CAPD) that can necessitate cessation of CAPD. Hemodialysis was started on a 52-year-old woman and shifted to CAPD 1 month later. However, 18 days after initiation of CAPD, her chest radiograph showed a right-side hydrothorax. Thoracentesis yielded a colorless pleural effusion with markedly higher glucose levels than in her serum, indicating the presence of pleuroperitoneal communication. Three days later, thoracoscopic surgery was performed. A colored dialysis solution preoperatively injected into the abdominal cavity identified intraoperatively leakage from the diaphragm. The leakage points were closed by a no-knife-type automatic stapler with absorbable polyglycolic acid felt and fibrin glue. CAPD was restarted on the operative day, and there was no recurrence of the right hydrothorax. We conclude that this simple method can be used effectively to treat pleuroperitoneal communication.
Kumagai
Hajime
H
Department of Thoracic Surgery, Hiroshima General Hospital, Hiroshima, Japan. hzm2525kum@yahoo.co.jp
Watari
Masanobu
M
Kuratsune
Masatoshi
M
D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D006876:Hydrothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010532:Peritoneal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010995:Pleural Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011100:Polyglycolic Acid / Q000627:therapeutic use; D011859:Radiography; D013528:Surgical Staplers; D013906:Thoracoscopy / Q000379:methods*; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D011100:Polyglycolic Acid