Kennedy C, McCarthy C, Alken S, McWilliams J, Morgan R K, Denton M, Conlon P J, Magee C
Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland.
Int J Nephrol. 2011;2011:526753. doi: 10.4061/2011/526753. Epub 2011 Aug 17.
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.
诸如腹壁疝等与压力相关的并发症在腹膜透析患者中相对常见。较少见的情况下，会出现含有透析液的漏出性胸腔积液。这种现象似乎是由于先天性或后天性膈肌缺陷导致腹腔内压力升高所致。我们报告了在我们机构9个月内发生的3例胸膜腹膜瘘病例。我们回顾了关于该主题的文献，并讨论了管理方案。1例患者在进行腹膜引流并转为血液透析后胸腔积液消退。1例患者需要紧急胸腔穿刺术。第3例患者出现复杂的胸腔积液，需要手术干预。这3例病例突出了这种情况在发生时间、症状和管理方面的变异性。胸膜腹膜瘘的诊断很重要，因为其管理方式与该患者群体中大多数漏出性胸腔积液的管理方式有很大不同。对于那些希望恢复腹膜透析的患者或有复杂胸腔积液的患者，可能需要进行手术修复。在腹膜透析患者胸腔积液的鉴别诊断中，尤其是右侧胸腔积液，应考虑胸膜腹膜瘘。
