Ria Paolo, Luongo Luca, Martella Vilma, Zito Anna, Matino Silvia, Barbarini Silvia, Protopapa Paolo, Gianfreda Davide, De Pascalis Antonio, Andriolo Luigi Gaetano
Nephrology, Dialysis, and Renal Transplantation Unit, Vito Fazzi Hospital, Lecce, Italy.
Department of Nuclear Medicine, Vito Fazzi Hospital, Lecce, Italy.
Am J Case Rep. 2025 Aug 2;26:e947860. doi: 10.12659/AJCR.947860.
BACKGROUND Pleuroperitoneal communication (PPC) is a rare yet significant complication in patients undergoing peritoneal dialysis (PD), characterized by an abnormal connection between the peritoneal and pleural cavities. This condition can lead to pleural effusion, respiratory complications, and, in severe cases, necessitate the discontinuation of PD in favor of hemodialysis, threatening residual renal function. While the incidence of PPC is low (1-6%), it presents considerable diagnostic and therapeutic challenges, often requiring a multidisciplinary approach. CASE REPORT We report 2 cases of PPC managed at our center, highlighting the role of advanced diagnostic and therapeutic strategies. Both cases were diagnosed via peritoneal scintigraphy using 99mTc-labeled albumin and confirmed with computed tomography (CT). The first case, a female patient, transitioned to extracorporeal dialysis following diagnosis. The second case, a male patient, initially underwent conservative management with a very-low-protein diet for 45 days. Follow-up scintigraphy showed resolution of the leakage. However, approximately 1 month after resuming peritoneal dialysis, he had a recurrence. After implementation of an optimized nutritional protocol and a consultation with a thoracic surgeon, a decision was made to proceed with minimally invasive repair via video-assisted thoracic surgery (VATS). This approach included defect closure with Prolene® sutures and fibrin glue application. VATS allowed resolution of the complication and postoperative PD resumption with reduced volumes. CONCLUSIONS Our findings emphasize the importance of early diagnosis using advanced imaging, tailored nutritional therapy to bridge treatment, and minimally invasive surgical techniques to preserve PD and renal function. Peritoneal scintigraphy offers high precision in mapping the anatomical defect, facilitating targeted surgical intervention VATS. Combined with preoperative imaging, it proved to be a precise and effective intervention. Dietary intervention successfully prevented the transition to extracorporeal dialysis. A multidisciplinary team involving nephrologists, thoracic surgeons, nuclear medicine specialists, and dietitians was crucial for optimizing outcomes. Future research should focus on standardizing diagnostic protocols and surgical techniques to improve PPC management, reduce recurrence, and enhance patient quality of life.
背景 胸膜腹膜瘘（PPC）是腹膜透析（PD）患者中一种罕见但严重的并发症，其特征为腹膜腔与胸膜腔之间存在异常连接。这种情况可导致胸腔积液、呼吸并发症，严重时需要停止腹膜透析转而进行血液透析，从而威胁残余肾功能。虽然PPC的发生率较低（1% - 6%），但它带来了相当大的诊断和治疗挑战，通常需要多学科方法。病例报告 我们报告了在我们中心处理的2例PPC病例，突出了先进诊断和治疗策略的作用。两例均通过使用99mTc标记白蛋白的腹膜闪烁显像诊断，并经计算机断层扫描（CT）证实。第一例为女性患者，诊断后转为体外透析。第二例为男性患者，最初采用极低蛋白饮食进行了45天的保守治疗。随访闪烁显像显示渗漏消失。然而，在恢复腹膜透析约1个月后复发。在实施优化的营养方案并咨询胸外科医生后，决定通过电视辅助胸腔镜手术（VATS）进行微创修复。该方法包括用普理灵®缝线封闭缺损并应用纤维蛋白胶。VATS使并发症得到解决，术后腹膜透析得以恢复，且透析液用量减少。结论 我们的研究结果强调了使用先进影像学进行早期诊断、采用量身定制的营养疗法以过渡治疗以及采用微创外科技术来保留腹膜透析和肾功能的重要性。腹膜闪烁显像在描绘解剖缺损方面具有高精度，有助于进行有针对性的手术干预VATS。结合术前影像学检查，它被证明是一种精确有效的干预措施。饮食干预成功防止了转为体外透析。一个由肾病学家、胸外科医生、核医学专家和营养师组成的多学科团队对于优化治疗结果至关重要。未来的研究应专注于规范诊断方案和手术技术，以改善PPC的管理、减少复发并提高患者生活质量。
