Related Experiment Videos
Surgical correction of hydrothorax from diaphragmatic eventration in children on peritoneal dialysis
H S Bjerke1, E S Adkins, R P Foglia
1Division of Pediatric Surgery, University of California, Los Angeles.
Insights
Massive hydrothorax during continuous ambulatory peritoneal dialysis (CAPD) in children, often caused by diaphragmatic defects, can be successfully treated with surgical repair, allowing a return to CAPD therapy.
Area of Science:
- Nephrology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for pediatric renal failure.
- While generally well-tolerated, a rare complication is massive unilateral hydrothorax, affecting ~2% of children.
- This complication often necessitates switching to hemodialysis.
Observation:
- Three pediatric patients undergoing CAPD developed massive unilateral hydrothorax.
- Occult diaphragmatic defects were identified as the likely cause of this complication.
Findings:
- All three patients underwent thoracotomy for surgical repair of diaphragmatic eventration.
- Successful repair allowed for immediate resumption of CAPD therapy in all cases.
Implications:
- This study presents the first report of successful surgical management of massive hydrothorax in pediatric CAPD patients.
- Diaphragmatic defect repair offers a viable treatment option, potentially avoiding permanent discontinuation of peritoneal dialysis in children.
Abstract:
Continuous ambulatory peritoneal dialysis (CAPD) is frequently used in the pediatric age group for reversible and end-stage renal failure. Most pediatric patients tolerate this therapy with few complications. Approximately 2% of children, however, develop massive unilateral hydrothorax. This major complication usually results in the discontinuation of peritoneal dialysis in all forms and the institution of hemodialysis. Occult diaphragmatic defects account for most adult and pediatric patients who develop this complication. Three pediatric patients receiving CAPD complicated by massive hydrothorax are described. All patients were successfully treated by thoracotomy and repair of the diaphragmatic eventration with an immediate return to CAPD. This is the first report of successful therapy of this kind in children. A review of the cause, diagnosis, and treatment of massive hydrothorax developing during CAPD therapy is presented.