García Romero José Manuel, Guerrero Morales Pedro Hugo, Alegria Arias Ana Laura, de Noriega Guzmán Daniela, Bulle Parra Mariana
Transplant and Donation Department, Regional General Hospital 1 of the Mexican Social Security Institute, Querétaro, MEX.
General Practice, Health Clinic 56 Amealco of the Mexican Social Security Institute, Querétaro, MEX.
Cureus. 2024 Sep 9;16(9):e69034. doi: 10.7759/cureus.69034. eCollection 2024 Sep.
A pleuroperitoneal fistula, an uncommon complication of peritoneal dialysis, involves a connection between the peritoneal cavity and the pleural space. This case highlights a cost-effective diagnostic option for detecting these fistulas in primary care hospitals and emphasizes the importance of considering this condition in patients with a history of peritoneal dialysis and persistent pleural effusion. We present a case of a 55-year-old female patient undergoing peritoneal dialysis for end-stage renal disease who developed a pleuroperitoneal fistula, leading to persistent pleural effusion. This condition was successfully diagnosed using methylene blue instillation into the dialysis bags, demonstrating a potentially viable diagnostic technique that is effective, safe, and cost-efficient for primary and secondary care hospitals. The presented case underscores that pleural effusion, as a complication with high mortality, should be considered in any patient with end-stage renal disease presenting with dyspnea, desaturation, and pleuritic pain secondary to peritoneal dialysis sessions. Furthermore, the use of methylene blue is proposed as a cost-effective and accessible diagnostic alternative. This approach not only facilitates accurate diagnosis but also simplifies the diagnostic process without relying on advanced imaging technologies that might not be available.
胸膜腹膜瘘是腹膜透析的一种罕见并发症，它涉及腹膜腔与胸膜腔之间的连通。本病例突出了在基层医院检测这些瘘管的一种经济有效的诊断方法，并强调了在有腹膜透析病史且持续存在胸腔积液的患者中考虑这种情况的重要性。我们报告一例55岁女性患者，因终末期肾病接受腹膜透析，发生了胸膜腹膜瘘，导致持续性胸腔积液。通过向透析袋中注入亚甲蓝成功诊断了这种情况，这表明对于基层和二级医疗机构而言，这是一种有效、安全且经济高效的潜在可行诊断技术。该病例强调，对于任何因腹膜透析出现呼吸困难、低氧血症和胸膜炎性疼痛的终末期肾病患者，都应考虑胸腔积液这种具有高死亡率的并发症。此外，建议使用亚甲蓝作为一种经济有效且易于获得的诊断选择。这种方法不仅有助于准确诊断，还简化了诊断过程，无需依赖可能无法获得的先进成像技术。
