Advanced Strategies for Managing Pleuroperitoneal Communication in Peritoneal Dialysis Patients: Report of Two Cases

Abstract

Objective: Unusual clinical course Background: Pleuroperitoneal communication (PPC) is a rare yet significant complication in patients undergoing peritoneal dialysis (PD), characterized by an abnormal connection between the peritoneal and pleural cavities. This condi-tion can lead to pleural effusion, respiratory complications, and, in severe cases, necessitate the discontinuation of PD in favor of hemodialysis, threatening residual renal function. While the incidence of PPC is low (1-6%), it presents considerable diagnostic and therapeutic challenges, often requiring a multidisciplinary approach. Case Reports: We report 2 cases of PPC managed at our center, highlighting the role of advanced diagnostic and therapeutic strategies. Both cases were diagnosed via peritoneal scintigraphy using 99mTc-labeled albumin and con-firmed with computed tomography (CT). The first case, a female patient, transitioned to extracorporeal dialysis following diagnosis. The second case, a male patient, initially underwent conservative management with a very-low-protein diet for 45 days. Follow-up scintigraphy showed resolution of the leakage. However, approxi-mately 1 month after resuming peritoneal dialysis, he had a recurrence. After implementation of an optimized nutritional protocol and a consultation with a thoracic surgeon, a decision was made to proceed with minimally invasive repair via video-assisted thoracic surgery (VATS). This approach included defect closure with Prolene® sutures and fibrin glue application. VATS allowed resolution of the complication and postoperative PD resumption with reduced volumes. Conclusions: Our findings emphasize the importance of early diagnosis using advanced imaging, tailored nutritional therapy to bridge treatment, and minimally invasive surgical techniques to preserve PD and renal function. Peritoneal scintigraphy offers high precision in mapping the anatomical defect, facilitating targeted surgical intervention VATS. Combined with preoperative imaging, it proved to be a precise and effective intervention. Dietary intervention successfully prevented the transition to extracorporeal dialysis. A multidisciplinary team involving ne-phrologists, thoracic surgeons, nuclear medicine specialists, and dietitians was crucial for optimizing outcomes. Future research should focus on standardizing diagnostic protocols and surgical techniques to improve PPC management, reduce recurrence, and enhance patient quality of life.