Ambarsari Cahyani Gita, Bermanshah Evita Karianni, Putra Muhammad Arza, Rahman Farhan Haidar Fazlur, Pardede Sudung Oloan
Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia.
Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia.
Case Rep Nephrol Dial. 2020 Feb 12;10(1):18-25. doi: 10.1159/000506119. eCollection 2020 Jan-Apr.
Peritoneal dialysis (PD) confers many advantages, including a better quality of life for children with end-stage renal disease; however, the procedure is associated with several complications, including pleuroperitoneal leaks. Here, we report an unusual case of hydrothorax caused by long-term PD in a child, which was further complicated by pneumonia. A 9-year-old boy who had received CAPD for 22 months presented with dyspnea, swelling, and increased body weight. Chest tube drainage yielded 500 mL of transudative fluid. Computed tomography peritoneography revealed increased outflow from the peritoneum to the pleural cavity. PD was suspended, and hemodialysis (HD) was initiated. Video-assisted thoracoscopic surgery was performed; however, because the patient had pneumonia during hospitalization, pleural adhesions with a septated appearance occurred. This resulted in difficulties identifying pleuroperitoneal fistula (PPF). Right pleural effusion resolved following pleurodesis using bleomycin. Regular HD was performed for 10 weeks, and PD was subsequently reinitiated. There was no recurrence of hydrothorax during long-term follow-up. We suspect that the underlying mechanism of hydrothorax in our patient was associated with a PPF that formed either due to a congenital diaphragmatic defect or an acquired defect, resulting in dialysate leakage. Our case demonstrates that a temporary switch from PD to HD, accompanied by pleurodesis, may help resolve hydrothorax that occurs as a complication of long-term PD.
腹膜透析（PD）具有许多优点，包括能提高终末期肾病患儿的生活质量；然而，该操作会引发多种并发症，包括胸膜腹膜漏。在此，我们报告一例儿童因长期腹膜透析导致胸腔积液的罕见病例，该病例还并发了肺炎。一名接受持续性非卧床腹膜透析（CAPD）22个月的9岁男孩出现呼吸困难、肿胀及体重增加。胸腔闭式引流引出500毫升漏出液。计算机断层扫描腹膜造影显示从腹膜到胸膜腔的流出量增加。暂停腹膜透析，开始血液透析（HD）。进行了电视辅助胸腔镜手术；然而，由于患者住院期间患有肺炎，出现了有分隔外观的胸膜粘连。这导致难以识别胸膜腹膜瘘（PPF）。使用博来霉素进行胸膜固定术后，右侧胸腔积液消退。规律进行血液透析10周，随后重新开始腹膜透析。长期随访期间胸腔积液未复发。我们怀疑该患者胸腔积液的潜在机制与因先天性膈肌缺损或后天性缺损形成的胸膜腹膜瘘有关，导致透析液渗漏。我们的病例表明，从腹膜透析暂时转换为血液透析并同时进行胸膜固定术，可能有助于解决长期腹膜透析并发症所致的胸腔积液。
