Peritoneal-mediastinal communication complication in peritoneal dialysis

Area of Science:

• Nephrology
• Cardiology
• Surgical Complications

Background:

• A 36-year-old male with end-stage kidney disease (ESKD) secondary to calcineurin inhibitor nephrotoxicity and BK virus nephropathy post-heart transplantation was on continuous cycler peritoneal dialysis (CCPD).
• The patient had a history of multiple thromboses, rendering intermittent hemodialysis (iHD) via vascular access not feasible.

Observation:

• The patient presented with increased sternal incision drainage and reduced ultrafiltration.
• A contrast-enhanced chest CT scan identified an anterior chest wall subcutaneous fluid collection.
• Intraoperative findings confirmed a peritoneal-mediastinal communication.

Findings:

• A rare complication, peritoneal-mediastinal communication, was diagnosed in a patient undergoing CCPD.
• Successful management was achieved using "low-volume" PD with reduced fill volumes, avoiding the need for iHD.
• This approach was critical given the patient's inability to undergo iHD due to unavailable vascular access.

Implications:

• Highlights the complex management of ESKD patients with surgical complications affecting PD.
• Demonstrates the feasibility of "low-volume" PD as an alternative in challenging cases.
• Underscores the necessity of a multidisciplinary approach for optimal patient care in complex ESKD management.