Pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis

A 46-year-old man with chronic renal failure caused by diabetes mellitus underwent continuous ambulatory peritoneal dialysis (CAPD). Approximately 6 months later, he complained of dyspnea. The patient's chest radiograph showed massive right pleural effusion (Figure 1). We drained the right pleural fluid, which was clear and yellowish. The concentration of glucose in the right pleural fluid (96mg/dl) was slightly higher than that in the serum (80mg/dl), suggesting right hydrothorax due to pleuroperitoneal communication (PPC). The diagnosis of PPC was confirmed by peritoneal scintigraphy using 99mTc-Sn-colloid. The radiotracer activity increased in the right pleural space within 5 min after 99mTc-Sn-colloid intraperitoneal injection through a CAPD catheter (Figure 2). Despite the condition, the patient requested to continue with CAPD; hence, video-assisted thoracoscopic surgery (VATS) was performed. Using a dialysis solution containing indigo carmine infused through a CAPD catheter, two fistulas on the right diaphragm were detected after the areas gradually stained blue. The fistulas on the diaphragm were directly sutured with 3-0 absorbable thread. In addition, the suture closure sites were covered using absorbable polyglycolic acid sheets and fibrin glue. The postoperative course was extremely favorable and CAPD was resumed at 7 days after the surgery.