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Peritoneopericardial communication after pericardiocentesis in a patient on continuous ambulatory peritoneal dialysis
1Division of Nephrology, National Taiwan University Hospital, Taipei, ROC.
Insights
Pericardiocentesis in patients on continuous ambulatory peritoneal dialysis (CAPD) may cause peritoneopericardial fistula. This rare complication requires careful consideration of the subxiphoid approach for dialysis pericarditis management.
Area of Science:
- Nephrology
- Cardiology
- Medical Imaging
Background:
- Dialysis pericarditis is a known complication in patients undergoing peritoneal dialysis.
- Massive pericardial effusion can be challenging to manage, especially when unresponsive to conservative treatments like hemodialysis.
Abstract:
A male patient aged 41 years had dialysis pericarditis with massive pericardial effusion in his 6-year on continuous ambulatory peritoneal dialysis (CAPD). Intensive hemodialysis failed to resolve the pericardial effusion. Pericardiocentesis via a subxiphoid approach was performed with placement of a pigtail catheter for drainage. A communication between peritoneal and pericardial cavities occurred, resulting in the leakage of the peritoneal dialysate into pericardial sac which was confirmed by a 99mTc radionuclide scan. The fistula healed after removal of the catheter and discontinuation of CAPD. We suggest that pericardiocentesis via a subxiphoid approach for pericardial effusion should be cautiously exercised in CAPD cases for fear of peritoneopericardial fistula.