title: Peritoneal-pericardial communication in an adolescent on peritoneal dialysis.
abstract: BACKGROUND
  Dialysate leakage into the pericardium is a rare but potentially life-threatening complication of peritoneal dialysis (PD). There has been one reported pediatric case of spontaneous peritoneo-pericardial fistula in a 2-year-old boy with tissue fragility due to malnutrition and two reported adult cases in PD patients with a history of previous cardiac surgery and/or pericardiocentesis.
  
  
  METHODS
  We describe a 15-year-old girl with end-stage renal disease secondary to granulomatosis with polyangiitis, with recurrent pericardial effusions secondary to a peritoneo-pericardial fistula while on continuous cycling peritoneal dialysis (CCPD). She had previously presented with chylous pericardial effusion that required pericardiocentesis and subsequently developed recurrent pericardial effusions when she was commenced on CCPD 9 months later. Pericardial fluid chemistry revealed a sterile, serous fluid containing 15.1 mmol/L of glucose and <0.11 mmol/L of triglycerides. Peritoneal scintigraphy with Tc-99m labeled sulfur colloid injected intra-peritoneally confirmed the presence of a peritoneo-pericardial fistula. The pericardial effusions resolved upon switching the patient to hemodialysis (HD).
  
  
  CONCLUSIONS
  Our case of recurrent pericardial effusions in a child on PD secondary to a peritoneo-pericardial fistula highlights the need for close follow-up in patients with a history of previous pericardiocentesis who are commenced on PD.
authors.affiliation: Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada.
authors.forename: Chia Wei
authors.initials: CW
authors.lastname: Teoh
authors.affiliation: Division of Radiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Nadel
authors.affiliation: Department of Pediatrics, Division of Cardiology, British Columbia Children's Hospital, Vancouver, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Armstrong
authors.affiliation: Department of Pediatrics, Division of Cardiology, British Columbia Children's Hospital, Vancouver, Canada.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Harris
authors.affiliation: Division of Nephrology, British Columbia Children's Hospital, 4480 Oak St, ACB K4-151, Vancouver, Canada, V6H 3V4. cwhite@cw.bc.ca.
authors.forename: Colin T
authors.initials: CT
authors.lastname: White
mesh_terms: D000293:Adolescent; D001202:Ascitic Fluid; D015314:Dialysis Solutions / Q000009:adverse effects*; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000175:diagnosis; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D020519:Pericardiocentesis; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010532:Peritoneal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D006435:Renal Dialysis; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D015314:Dialysis Solutions
keywords: Dialysate leakage; Pericardial effusions; Peritoneal fluid scintigraphy; Vasculitis