Case report: the thoracoscopic surgery in peritoneal-pleural leakage. A valid therapeutic strategy

Giada Giovanna Olga Bigatti, Brunilda Xhaferi, Elisa Nava, Lara Traversi, Daniele Ciurlino, Tiziana Mazzullo, Silvia Tedoldi, Stefania Martino, Margarita Nora Villa, Matteo Oriani, Massimo Castiglioni, Silvio Volmer Bertoli

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
JournalGiornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia
Volume37
Issue number4
Publication statusPublished - Aug 11 2020

Keywords

  • end stage renal disease
  • peritoneal dialysis
  • pleuro-peritoneal leakage
  • video-assisted thoracoscopic surgery

ASJC Scopus subject areas

  • Medicine(all)

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