Peritoneal Dialysis Complicated with Thoracoabdominal Fistula:A Case Report and Literature Review
Objective To discuss the causes and developments in treatment for peritoneal dialysis(PD)complicated with thoracoabdominal fistula,as well as its clinical symptoms,diagnosis,and differential diagnosis.Methods Clinical manifestations,routine and biochemical data from thoracoabdominal fluid,chest CT results,and radionuclide imaging results of a PD patient with a thoracoabdominal fistula admitted to Wuhan Fourth Hospital were examined,and the clinical manifestations,diagnosis,and treatment approaches were summarized.Results After receiving PD treatment for four months,the patient,a female,experienced an acute onset right thoracoabdominal fistula as well as symptoms of restrictive ventilation dysfunction such as chest tightness,panting,and coughing.While routine pleural fluid revealed no malignant cells,biochemical pleural fluid revealed low protein and elevated glucose concentration,and thoracoabdominal fistula radionuclide imaging revealed concentrated radiation distribution in the right thoracic cavity,the right thoracic cavity was equally filled with fluid according to color Doppler ultrasound and chest CT.The patient underwent thoracic puncture drainage,intermittent peritoneal dialysis(IPD)protocol correction,and conversion to hemodialysis(HD).Pleural fluid in the patient was significantly reduced,and problems such as a thoracoabdominal fistula never recurred.Although PD complicated with a thoracoabdominal fistula is uncommon,once it does,the best course of action should be taken to prevent damage to the cardiopulmonary system or perhaps a life-threatening condition.Conclusion PD is unlikely to be complicated with thoracoabdominal fistula,which mainly occurs within the first year of PD,is more common in women,and is more prevalent on the right side,often due to the difference in thoracoabdominal pressure.Various diagnostic methods are available,and surgical or nonsurgical treatment can be chosen,but most patients ultimately require HD.
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