Peritoneal Leak Causing Right Sided Hydrothorax in A Case of Chronic Kidney Disease Undergoing Continuous Ambulatory Peritoneal Dialysis: A Case Report From Nepal

Abstract

Continuous ambulatory peritoneal dialysis (CAPD) is used for the maintenance dialysis in patients with end stage renal disease. Treatment's complications in CAPD generally exist, of which transudate hydrothorax falls under the minority of the cases. Here, we aim to present a case of a 51 years old female, a newly diagnosed case of chronic kidney disease (CKD) undergoing CAPD for 3 weeks who presented at our institution with complaints of difficulty in breathing. The symptom had gradually progressed after her recent CAPD session. Several investigations were sought out, of which a chest X-ray illustrated a right sided hydrothorax. Pleural fluid analysis showed a transudate characteristic, and other diagnostic tests suggested that a peritoneal fluid leak might have caused the hydrothorax. CAPD induced hydrothorax is one of the uncommon noninfectious complications associated with peritoneal dialysis; its diagnosis can be made by studying both biochemical and radiological parameters of the patient. The definitive diagnosis is made by establishing a pleuro-peritoneal communication using peritoneal scintigraphy. An immediate halt in CAPD will allow the remission of hydrothorax as mentioned below in our case report. The definitive management includes video assisted thorascopic surgery with mechanical pleurodesis. An appropriate diagnostic and management approach should be sought in CAPD induced transudate hydrothorax. An immediate halt in CAPD with surgical interventions can be considered as a treatment options for such complication.