Pleuroperitoneal Leak in Peritoneal Dialysis: A Series of 10 Cases

Abstract

Pleuroperitoneal Leak (PPL) is a rare, but serious complication of Peritoneal Dialysis (PD). It is the result of congenital or acquired communication between the 2 peritoneal and pleural cavities, and is often linked to high Intra-Abdominal Pressures (IAP). Its diagnosis is clinical, radiological and biological. In this article, we report 10 cases of PPL identified over a period of 13 years (2006-2019), that is to say, a prevalence of 5%. We suspected the diagnosis of FPP in front of dyspnea alone in 5 cases (50%), dyspnea associated with cough in 4 cases (40%). Catheter migration was reported in 5 patients (50% of cases). None of our patients presented with peritonitis before FPP. The pleurisy was right in 7 patients (70%). The exploratory puncture of the Pleural Fluid (PF) was performed in 3 patients, and which showed results consistent with the PD fluid. The drop in infusion volumes was required in 4 patients (40%) with an increase in the number of daily exchanges of CAPD with IVs ranges from 1200 - 1500 ml. PD was suspended in 6 patients (60%) for an average of 40 days (21 days - 60 days), 2 withdrawals from the technique were reported after the 2nd recurrence (20%). PD was stopped straight away in 1 patient with a hypo-permeable peritoneum with unsatisfactory residual renal function and a second who freely chose to stay in HD. The clinical cases presented show the great variability of FPP in terms of clinical and radiological presentation and therapeutic management, and focus on the significant risk of a transient or permanent withdrawal from the technique. According to literature data, Video-assisted thoracoscopic surgery appears to be promising in the event of failure of conservative treatment, and will thus prolong the survival of the technique.