Peritoneal Dialysis-Associated Hydrothorax and Hernia

Abstract

An 8-month-old male infant with autosomal recessive polycystic kidney disease (ARPKD), necessitating bilateral nephrectomy in the fifth month of life, presented with acute tachypnea and hypotension 9 weeks after automated peritoneal dialysis (PD) commencement. Chest X-ray showed right-sided pleural effusion, and radiography with intraperitoneal installation of contrast agent established the diagnosis of paraesophageal leakage into the pleural space. Subsequent contrast thoracoscopy with intraperitoneal administration of methylene blue failed to demonstrate the site of the leakage. Hence, PD with reduced fill volumes was resumed. Two weeks later the patient developed acute respiratory distress while on cycler. Open surgery demonstrated a 3 cm cleft in the right diaphragm. After its surgical closure, PD could be resumed successfully, but when fill volume was increased to 1000 ml/m², the patient developed a bilateral inguinal hernia, which required surgical repair.