scholarly journals Pleuroperitoneal Leak Complicating Peritoneal Dialysis: A Case Series

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
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.

scholarly journals IgG4-related intracranial disease

2018 ◽  
Vol 32 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Shahine Goulam-Houssein ◽  
Jeffrey L Grenville ◽  
Katerina Mastrocostas ◽  
David G Munoz ◽  
Amy Lin ◽  
...  
Keyword(s):  
Plasma Cells ◽  
Surgical Intervention ◽  
Case Series ◽  
Hypertrophic Pachymeningitis ◽  
Diagnostic Challenge ◽  
Perineural Spread ◽  
Related Disease ◽  
The Third ◽  
Igg4 Related Disease ◽  
Intracranial Involvement

IgG4-related disease (IgG4-RD) is a multi-organ chronic inflammatory process caused by infiltration of IgG4-positive plasma cells in one or more organs. Intracranial involvement has only recently become better recognized. Our case series adds to the growing literature on the varying presentations of intracranial IgG4 by describing the clinical and imaging findings of three patients who presented to our institution with intracranial involvement. Our first patient presented with a mass-forming IgG4 pachymeningitis mimicking a sphenoid wing meningioma, which is to our knowledge the largest mass-forming pachymeningitis published in the literature. Our second case depicts another presentation of extensive IgG4 pachymeningitis involving both cavernous sinuses and surrounding Meckel’s caves. The third case describes a patient with presumed lymphocytic hypophysitis, which was later determined to be IgG4-related hypophysitis with concomitant pachymeningitis and perineural spread along the optic nerves. The delayed diagnoses in our cases illustrates the diagnostic challenge that clinicians face in differentiating intracranial IgG4-RD from other infiltrative diseases such as sarcoidosis, granulomatous disease, tuberculosis and lymphoma. Earlier consideration of IgG4-related hypophysitis and hypertrophic pachymeningitis in the differential diagnosis can prevent significant morbidity including unnecessary surgical intervention and organ failure secondary to extensive fibrosis.

Surgical correction of hydrothorax complicating pediatric peritoneal dialysis

2020 ◽  
pp. 089686082092345
Author(s):  
Yonique Petgrave ◽  
Brittany Johnson ◽  
Shweta Shah ◽  
Paul Minifee ◽  
Sarah J Swartz
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Surgical Correction ◽  
Diaphragmatic Defect ◽  
Direct Visualization ◽  
Initial Approach ◽  
Video Assisted ◽  
Initiation Of Dialysis ◽  
Continuous Cycling

Hydrothorax complicating continuous cycling peritoneal dialysis (CCPD) is an uncommon event. Its presentation may occur shortly after or years after initiation of dialysis. Surgical intervention offers the advantage of direct visualization and repair of the diaphragmatic defect. Video assisted thoracoscopy surgery (VATS) has been increasingly used in identifying these defects to facilitate this repair. We present 2 pediatric cases who underwent successful direct surgical repair of diaphragmatic defects using VATS with return to CCPD. Initial approach with VATS should be strongly considered in patients in whom a lifetime change in modality has significant repercussions.

Laparoscopic Surgery in Patients on Peritoneal Dialysis: A Review of the Literature

2017 ◽  
Vol 24 (4) ◽  
pp. 397-401 ◽  
Author(s):  
Giulio Mari ◽  
Renzo Scanziani ◽  
Sara Auricchio ◽  
Jacopo Crippa ◽  
Dario Maggioni
Keyword(s):  
Peritoneal Dialysis ◽  
Laparoscopic Surgery ◽  
End Stage Renal Disease ◽  
Open Surgery ◽  
Surgical Intervention ◽  
Case Series ◽  
Laparoscopic Technique ◽  
Review Of The Literature ◽  
Stage Renal Disease ◽  
End Stage

Peritoneal dialysis (PD) is an effective renal replacement therapy for the treatment of end-stage renal disease. Patients on PD undergoing abdominal open surgery often fail to resume PD. Laparoscopic surgery has recently become a serious alternative to open surgery in patients on PD to treat different abdominal pathologies. However, only a few studies have reported successful procedures without Tenckhoff catheter removal. The aim of this review is to describe how a laparoscopic technique can allow PD patients to deal with abdominal surgery without shifting to hemodialysis. Only 50 cases of laparoscopic surgical intervention in PD patients have been published to our knowledge. These case series largely concern laparoscopic cholecystectomies, appendectomies, nephrectomies, colectomies, and bariatric procedures. The reported cases show how laparoscopic surgery can be accepted as a valid option for several abdominal surgical procedures in patients on PD with good outcomes and early resumption of PD.

Management of pleural effusion and haemothorax

2016 ◽  
Author(s):  
Davide Chiumello ◽  
Silvia Coppola
Keyword(s):  
Pleural Effusion ◽  
Symptomatic Relief ◽  
Underlying Disease ◽  
Pleural Space ◽  
Bacterial Invasion ◽  
Pleural Effusions ◽  
Management Options ◽  
External Drainage ◽  
Malignant Effusions ◽  
Pleural Catheter

The main goal of management of pleural effusion is to provide symptomatic relief removing fluid from the pleural space. The options depend on type, stage, and underlying disease. The first diagnostic instrument is the chest radiography, while ultrasound can be very useful to guide thoracentesis. Pleural effusion can be a transudate or an exudate. Generally, a transudate is uncomplicated effusion treated by medical therapy, while an exudative effusion is considered complicated effusion and should be managed by drainage. Refractory non-malignant effusions can be transudative (congestive heart failure, cirrhosis, nephrosis) or exudative (pancreatitis, connective tissue disease, endocrine dysfunction), and the management options include repeated therapeutic thoracentesis, in-dwelling pleural catheter for intermittent external drainage, pleuroperitoneal shunts for internal drainage, or surgical pleurectomy. Parapneumonic pleural effusions can be classified as complicated when there is persistent bacterial invasion of the pleural space, uncomplicated and empyema with specific indications for pleural fluid drainage. Malignancy is the most common cause of exudative pleural effusions in patients aged >60 years and the decision to treat depends upon the presence of symptoms and the underlying tumour type. Options include in-dwelling pleural catheter drainage, pleurodesis, pleurectomy, and pleuroperitoneal shunt. Haemothorax needs to be differentiated from a haemorrhagic pleural effusion and, when suspected, the essential management is intercostal drainage. It achieves two objectives to drain the pleural space allowing expansion of the lung and to allow assessment of rates of blood loss to evaluate the need for emergency or urgent thoracotomy.

Pathophysiology and causes of haemoptysis

2016 ◽  
Author(s):  
Francesco Blasi ◽  
Paolo Tarsia
Keyword(s):  
Pleural Effusion ◽  
Symptomatic Relief ◽  
Underlying Disease ◽  
Pleural Space ◽  
Bacterial Invasion ◽  
Pleural Effusions ◽  
Management Options ◽  
Indwelling Pleural Catheter ◽  
Malignant Effusions ◽  
Pleural Catheter

The main goal of management of pleural effusion is to provide symptomatic relief removing fluid from pleural space and the options depend on type, stage and underlying disease. The first diagnostic instrument is the chest radiography while ultrasound can be very useful to guide thoracentesis. Pleural effusion can be a transudate or an exudate. Generally a transudate is uncomplicated effusion treated by medical therapy, while an exudative effusion is considered complicated effusion and should be managed by drainage. Refractory non-malignant effusions can be transudative (congestive heart failure, cirrhosis, nephrosis) or exudative (pancreatitis, connective tissue disease, endocrine dysfunction), and the management options include repeated therapeutic thoracentesis, indwelling pleural catheter for intermittent external drainage, pleuroperitoneal shunts for internal drainage, or surgical pleurectomy. Parapneumonic pleural effusions can be divided in complicated when there is persistent bacterial invasion of the pleural space, uncomplicated and empyema with specific indications for pleural fluid drainage. Malignancy is the most common cause of exudative pleural effusions in patients aged >60 years and the decision to treat depends upon the presence of symptoms and the underlying tumour type. Options include indwelling pleural catheter drainage, pleurodesis, pleurectomy and pleuroperitoneal shunt. Hemothorax needs to be differentiated from a haemorrhagic pleural effusion and when is suspected the essential management is the intercostal drainage. It achieves two objectives to drain the pleural space allowing expansion of the lung and to allow assessment of rates of blood loss to evaluate the need for emergency or urgent thoracotomy.

scholarly journals Case series of iatrogenic coronary stent avulsion: a rare complication with varied management strategies

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Majd B Protty ◽  
Elinor H M O’Neill ◽  
Tim Kinnaird ◽  
Sean Gallagher
Keyword(s):  
Rare Complication ◽  
Management Strategies ◽  
Case Series ◽  
Coronary Stent ◽  
Management Options ◽  
Aortic Sinus ◽  
Coronary Syndrome ◽  
The Third ◽  
First Case ◽  
The Wire

Abstract Background Coronary stent avulsion is a rare, infrequently reported complication of percutaneous coronary intervention (PCI) with no consensus on management options. Case summary This case series presents three descriptions of iatrogenic coronary stent avulsions, and three different bailout management strategies. All patients presented with acute coronary syndrome and required PCI. In the first case, a freshly implanted stent was entrapped in a coronary guidewire and avulsed upon withdrawal of the wire into the aortic sinus. In the second case, a staged procedure to implant a new stent was complicated by stent dislodgement and entanglement with a recently implanted stent leading to avulsion of both stents into the aortic sinus and resultant dissection to the coronary arteries. In the third case, following a successful stent implantation, the tip of the coronary guidewire was bound to the proximal edge of the stent resulting in avulsion of the newly implanted stent into the ascending aorta upon retraction of the wire at the end of the procedure. The first two patients were managed percutaneously, and the third surgically. All patients have had acceptable technical and clinical outcomes. Discussion In the absence of a consensus on best bailout management strategy, we discuss the mechanisms of and the potential management options for this rare, but serious, complication.

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

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Jun Ino ◽  
Haruna Kaneko ◽  
Eri Kasama ◽  
Mio Kodama ◽  
Keitaro Sato ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Pleural Effusion ◽  
Total Gastrectomy ◽  
Neuroendocrine Tumors ◽  
Clinical Course ◽  
Abdominal Cavity ◽  
Perioperative Period ◽  
Abdominal Pressure ◽  
Bacterial Peritonitis ◽  
Pleuroperitoneal Communication

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.

scholarly journals Intrapleural Tenecteplase for Complicated Parapneumonic Pleural Effusion

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Husain Kadhem ◽  
Kannan Sridharan ◽  
Naser Naser
Keyword(s):  
Pleural Effusion ◽  
Plasminogen Activator ◽  
Case Series ◽  
Pleural Effusions ◽  
Tissue Specific ◽  
Surgical Interventions ◽  
Parapneumonic Pleural Effusion ◽  
Bleeding Episodes

Intrapleural thrombolytics have shown promising results in complicated parapneumonic pleural effusions reducing the need for surgical interventions. Until now, studies have evaluated primarily streptokinase, urokinase, and recently, alteplase. In this case series, we share our experience with tenecteplase—a tissue-specific plasminogen activator in 15 patients. We observed that tenecteplase is effective in 14/15 (93.3%) of our patients, and none of them had any bleeding episodes.

scholarly journals Retrobulbar hematoma following the repair of an orbital wall fracture: a case series

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Jeong-Mo Kim
Keyword(s):  
Surgical Repair ◽  
Rare Complication ◽  
Case Series ◽  
Definite Diagnosis ◽  
Case Presentation ◽  
Loss Of Vision ◽  
The Third ◽  
Retrobulbar Hematoma ◽  
Orbital Wall ◽  
Permanent Loss

Abstract Background Retrobulbar hematoma is a rare complication after the repair of an orbital wall fracture, but the caution is required because the condition can cause blindness. Case presentation In this article, 3 cases of retrobulbar hematoma after the surgical repair of an orbital wall fracture are reported. In the first patient, the permanent loss of vision was involved, while in the second patient, the author was able to prevent loss of vision by performing immediate decompression after definite diagnosis and consulting with an ophthalmologist. In the third patient, there was no surgical treatment involved; he recovered on his own without major sequelae. Conclusions Retrobulbar hematoma is a very serious condition that can result in blindness. Thus, when it is recognized, every effort should be made to preserve the patient’s vision and prevent blindness.

scholarly journals Pleuroperitoneal Leak as an Uncommon Cause of Pleural Effusion in Peritoneal Dialysis: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Minh Huan Dang ◽  
Mathew Mathew ◽  
Rajesh Raj
Keyword(s):  
Peritoneal Dialysis ◽  
Case Report ◽  
Pleural Effusion ◽  
Gold Standard ◽  
Pleural Effusions ◽  
Biochemical Tests ◽  
Talc Pleurodesis ◽  
Advantages And Disadvantages ◽  
Fluid Analysis ◽  
Important Complication

Pleural effusions are frequently seen in patients on dialysis. A pleuroperitoneal leak or communication is a rare but important cause of pleural effusion in patients on peritoneal dialysis. This diagnosis can be made with a combination of biochemical tests and radiological modalities, in the absence of a gold standard diagnostic test. In addition to thoracocentesis, treatment often involves cessation of peritoneal dialysis and transition to hemodialysis. We describe a case of an 80-year-old man who presented with unilateral right-sided pleural effusion. He underwent therapeutic thoracocentesis and was subsequently diagnosed with a pleuroperitoneal leak through pleural fluid analysis. Peritoneal dialysis was ceased, and he transitioned temporarily to hemodialysis. He was subsequently treated with talc pleurodesis and successfully recommenced on peritoneal dialysis at six weeks after operation. In our report, we also review diagnostic imaging modalities, as well as advantages and disadvantages of each modality. A pleuroperitoneal leak is a rare but important complication of peritoneal dialysis and needs consideration in any patient on peritoneal dialysis presenting with unilateral pleural effusion.

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