Pleuroperitoneal communication after bacterial peritonitis and total gastrectomy for gastric neuroendocrine tumors: a case report and brief literature review

Abstract Background Peritoneal dialysis (PD) is associated with various complications, some of which may result in its discontinuation. Pleuroperitoneal communication (PPC) is commonly recognized by the presence of a diaphragmatic defect and pressure elevation in the abdominal cavity due to the dialysate. PPC is unpredictable and its presence prevents the continuation of PD. We present the clinical course and pathological findings of PPC in a PD patient after bacterial peritonitis and total gastrectomy for gastric neuroendocrine tumors. We provide a brief review of PD-related complications that develop due to a non-infectious pathology, including those related to catheter use and an elevated intra-abdominal pressure. Case presentation A 65-year-old Japanese man, who had been receiving PD treatment for 1 year, visited our hospital owing to a cloudy dialysate. Bacteria were detected in the dialysate. He had been previously diagnosed with gastric neuroendocrine tumors and gastrectomy had been planned. On admission, we started a 14-day antibiotic treatment for PD-related peritonitis. The patient showed a good clinical course. Gastrectomy was performed as planned, and the postoperative course was uneventful. During the perioperative period, PD was temporally changed to hemodialysis. Five weeks after the gastrectomy, PD treatment was resumed with gradual increase in the exchange volume. After returning to PD overnight, using an automated peritoneal dialysis machine, the patient complained of breathing difficulty and he gained weight. Right-sided pleural effusion was observed on a chest radiograph, and PPC was confirmed by scintigraphy when a mixture of technetium-99m and dialysate was seen entering the right hemithorax within 120 min. The patient did not consent to surgery for the PPC and he hoped to continue to receive PD treatment conservatively. We advised the patient to undergo dialysate exchange in a semi-seated position, and he was prohibited from lying down during the daytime. He continued PD treatment without signs of pleural effusion and over-volume. Conclusions This case of PPC occurring after bacterial peritonitis and total gastrectomy for gastric neuroendocrine tumors in a PD patient demonstrates the necessity of recognizing the PPC pathology in PD management and establishing methods for preventing PPC development after bacterial peritonitis or surgical procedures.

Download Full-text

270 Symptomatic Icodextrin Right Pleural Effusion from Suspected Pleuroperitoneal Communication: The Utility of Simultaneous Biochemical Fingerprinting Analysis of Drained Pleural Fluid and Peritoneal Dialysis Fluid

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2019.03.272 ◽

2019 ◽

Vol 73 (5) ◽

pp. 713

Keyword(s):

Peritoneal Dialysis ◽

Pleural Effusion ◽

Pleural Fluid ◽

Dialysis Fluid ◽

Fingerprinting Analysis ◽

Pleuroperitoneal Communication ◽

Peritoneal Dialysis Fluid ◽

Biochemical Fingerprinting

Download Full-text

Pleuroperitoneal Leak Complicating Peritoneal Dialysis: A Case Series

International Journal of Nephrology ◽

10.4061/2011/526753 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 8

Author(s):

C. Kennedy ◽

C. McCarthy ◽

S. Alken ◽

J. McWilliams ◽

R. k. Morgan ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Pleural Effusion ◽

Relative Frequency ◽

Surgical Repair ◽

Surgical Intervention ◽

Case Series ◽

Abdominal Pressure ◽

Pleural Effusions ◽

Management Options ◽

The Third

Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.

Download Full-text

Effects of different techniques of peritoneal dialysis at the intra-abdominal pressure in a newborn

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2021-25-2-95-98 ◽

2021 ◽

Vol 25 (2) ◽

pp. 95-98

Author(s):

M. G. Rekhviashvili ◽

A. Yu. Razumovskiу ◽

A. I. Makulova ◽

S. A. Fomenko ◽

G. P. Tukabaev ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Abdominal Cavity ◽

Hemodynamic Instability ◽

Extremely Low Birth Weight ◽

Intraabdominal Pressure ◽

Abdominal Pressure ◽

Premature Newborns ◽

Flow Modification

Introduction. Peritoneal dialysis (PD) is considered a very effective care for newborns with severe acute renal injury , and it is a method of choice for treating newborns in the end-stage renal failure who require chronic renal replacement therapy (RRT). The classical modification of peritoneal dialysis involves the introduction of dialysis solution into the abdominal cavity, its presence there for a certain time (exposure time) and its passive evacuation from the abdominal cavity. However, this technique of peritoneal dialysis causes an increased intra-abdominal pressure leading to a number of complications. PD in premature newborns, including those with extremely low body weight, has a number of features associated with extremely immature organs and tissues. One more problem is hemodynamic instability in this category of patients. Besides, peritoneal dialysis in the classical modification accompanied by increase in the intra-abdominal pressure can cause hemodynamic and respiratory disorders. The purpose of this article is to demonstrate the effect of the modified peritoneal dialysis, developed by the authors, at the intraabdominal pressure and compare it with the classical approach.Material and methods. A method of flow peritoneal dialysis in premature newborns has been developed, which significantly reduces the effect of peritoneal dialysis at the intra-abdominal pressure. Intra-abdominal pressure monitoring was performed using the invasive low pressure meter IInd 500/75 Triton. The values of intra-abdominal pressure in children receiving renal replacement therapy with various modifications of peritoneal dialysis were compared.Results. Our observations show that peritoneal dialysis in the flow modification avoids sharp fluctuations in intra-abdominal pressure. Conclusion. In our opinion, flow modification of peritoneal dialysis may be the method of choice for replacement therapy in deeply premature infants with low and extremely low birth weight.

Download Full-text

FP595SYMPTOMATIC ICODEXTRIN RIGHT PLEURAL EFFUSION FROM SUSPECTED PLEUROPERITONEAL COMMUNICATION: THE UTILITY OF SIMULTANEOUS BIOCHEMICAL FINGERPRINTING ANALYSIS OF DRAINED PLEURAL FLUID AND PERITONEAL DIALYSIS FLUID

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz106.fp595 ◽

2019 ◽

Vol 34 (Supplement_1) ◽

Author(s):

MACAULAY ONUIGBO ◽

Nneoma Agbasi ◽

Bibek Karki ◽

Sana Khan ◽

Kramer Wahlberg

Keyword(s):

Peritoneal Dialysis ◽

Pleural Effusion ◽

Pleural Fluid ◽

Dialysis Fluid ◽

Fingerprinting Analysis ◽

Pleuroperitoneal Communication ◽

Peritoneal Dialysis Fluid ◽

Biochemical Fingerprinting

Download Full-text

Laparoscopic approach for surgical treatment of pleuroperitoneal communication interfering with peritoneal dialysis: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01228-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Satoko Yorinaga ◽

Takehiro Maki ◽

Noriko Kawai ◽

Hiroyuki Kaneko ◽

Kenjiro Misu ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Case Report ◽

Surgical Treatment ◽

Pleural Effusion ◽

Laparoscopic Approach ◽

Fistula Closure ◽

Thoracoscopic Approach ◽

Case Presentation ◽

Pleuroperitoneal Communication ◽

The Right

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.

Download Full-text

Distinct clinical course of neuroendocrine tumors presenting ectopic ACTH tissue expression and secretion

Endocrine Abstracts ◽

10.1530/endoabs.70.ep13 ◽

2020 ◽

Author(s):

Michalina Oszywa ◽

Martyna Borowczyk ◽

Ewelina Szczepanek-Parulska ◽

Paweł Gut ◽

Marek Ruchała

Keyword(s):

Neuroendocrine Tumors ◽

Clinical Course ◽

Tissue Expression ◽

Ectopic Acth

Download Full-text

A case of pleuroperitoneal communication in which establishing a laparoscopic pneumoperitoneum was useful for the detection of a fistula

Surgical Case Reports ◽

10.1186/s40792-021-01147-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Takehiko Manabe ◽

Kenji Ono ◽

Soichi Oka ◽

Yuichiro Kawamura ◽

Toshihiro Osaki

Keyword(s):

Thoracic Surgery ◽

Surgical Repair ◽

Abdominal Cavity ◽

Case Presentation ◽

X Ray ◽

Video Assisted Thoracic Surgery ◽

Video Assisted ◽

Pleuroperitoneal Communication ◽

Small Pore ◽

Chest X Ray

Abstract Background Pleuroperitoneal communication (PPC) is rarely observed, accounting for 1.6% of all patients who undergo continuous ambulatory peritoneal dialysis (CAPD). Although there have been several reports concerning the management of this condition, we have encountered several cases in which control failed. We herein report a valuable case of PPC in which laparoscopic pneumoperitoneum with video-assisted thoracic surgery (VATS) was useful for supporting the diagnosis and treatment. Case presentation The patient was a 58-year-old woman with chronic renal failure due to chronic renal inflammation who was referred to a nephrologist in our hospital to undergo an operation for the induction of CAPD. Post-operatively, she had respiratory failure, and chest X-ray and computed tomography (CT) showed right-sided hydrothorax that decreased when the injection of peritoneal dialysate was interrupted. Therefore, PPC was suspected, and she was referred to our department for surgical repair. We planned surgical treatment via video-assisted thoracic surgery. During the surgery, we failed to detect any lesions with thoracoscopy alone; we therefore added a laparoscopic port at her right-sided abdomen near the navel and infused CO2 gas into the abdominal cavity. On thoracoscopy, bubbles were observed emanating from a small pore at the central tendon of the diaphragm, which was considered to be the lesion responsible for the PPC. We closed it by suturing directly. Conclusions VATS with laparoscopic pneumoperitoneum should be considered as an effective method for inspecting tiny pores of the diaphragm, especially when the lesions responsible for PPC are difficult to detect.

Download Full-text

Neutrophil Gelatinase-Associated Lipocalin as a Marker for Renal Dysfunction Detection in Critically Ill Patients with Increased Intraabdominal Pressure

The Journal of Critical Care Medicine ◽

10.1515/jccm-2017-0006 ◽

2017 ◽

Vol 3 (1) ◽

pp. 24-28

Author(s):

Claudiu Puiac ◽

Janos Szederjesi ◽

Alexandra Lazăr ◽

Codruța Bad ◽

Lucian Pușcașiu

Keyword(s):

Renal Function ◽

Intensive Care ◽

Creatinine Clearance ◽

Critically Ill ◽

Critically Ill Patients ◽

Abdominal Cavity ◽

Intraabdominal Pressure ◽

Abdominal Pressure ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

Abstract Introduction: Elevated intraabdominal pressure (IAP) it is known to have an impact on renal function trough the pressure transmitted from the abdominal cavity to the vasculature responsible for the renal blood flow. Intraabdominal pressure is found to be frequent in intensive care patients and also to be a predictor of mortality. Intra-abdominal high pressure is an entity that can have serious impact on intensive care admitted patients, studies concluding that if this condition progresses to abdominal compartment syndrome mortality is as high as 80%. Aim: The aim of this study was to observe if a link between increased intraabdominal pressure and modification in renal function exists (NGAL, creatinine clearance). Material and Method: The study enrolled 30 critically ill patients admitted in the Intensive Care Unit of SCJU Tîrgu Mures between November 2015 and August 2016. The study enrolled adult, hemodynamically stable patients admitted in intensive critical care - defined by a normal blood pressure maintained without any vasopressor or inotropic support, invasive monitoring using PICCO device and abdominal pressure monitoring. Results: The patients were divided into two groups based on the intraabdominal pressure values: normal intraabdominal pressure group= 52 values and increased intraabdominal group= 35 values. We compared the groups in the light of NGAL values, 24 hours diuresis, GFR and creatinine clearance. The groups are significantly different when compared in the light of NGAL values and GFR values. We obtained a statistically significant correlation between NGAL value and 24 hour diuresis. No other significant correlations were encountered between the studied items. Conclusions: NGAL values are increased in patients with high intraabdominal pressure which may suggest its utility as a cut off marker for patients with increased intraabdominal pressure. There is a significant decreased GFR in patient with elevated intraabdominal pressure, observation which can help in early detection of renal injury in patients due to high intraabdominal pressure. No correlation was found between creatinine clearance and increased intraabdominal pressure.

Download Full-text