Abstract: TH-PO842

A Way to Woman’s Heart Is through Her Stomach: A Case of a Pericardial-Peritoneal Fistula

Session Information

  • Peritoneal Dialysis - I
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Dave, Natasha Naresh, Baylor College of Medicine, Houston, Texas, United States
  • Yan, Jingyin, None, Houston, Texas, United States
Background

An exceedingly rare and potentially life-threatening complication of peritoneal dialysis (PD) is the development of a pericardial-peritoneal fistula (PPF). Typically this communication can occur in cases of pericardiocentesis or an embryological defect in diaphragmatic closure. We report a case of a young female who developed PPF after history of multiple pericardial windows.

Methods

A 26 year-old female with a history of end stage renal disease (ESRD) on PD presented to cardiology clinic for kidney transplant clearance. She was diagnosed with ESRD secondary to focal segmental glomerulosclerosis (FSGS) 6 months ago. At that time, she had a large pericardial effusion deemed uremic pericarditis warranting a sub-xiphoid pericardial window. She was initiated on hemodialysis (HD) then transitioned to PD and has since been compliant with a Kt/V above 2.0.

In clinic, an echocardiogram showed a large circumferential pericardial effusion and early right ventricular diastolic collapse. She was taken to surgery for drainage of pericardial effusion with pericardial biopsy and creation of pericardial window into the left pleural cavity. The biopsy showed fibrosis and mild chronic inflammation. Immediately after the surgery, she resumed PD.

Two weeks later, she developed shortness of breath (SOB) with exertion and orthopnea during dialysis. A chest X-ray revealed an enlarged cardiomediastinal silhouette and large left sided pleural effusion; she was taken to surgery. Intra-operatively the previous upper midline incision was dissected down to the subxiphoid matter. The surgeon was able to identify the defect in the pericardium that communicated with the abdominal cavity above the caudate lobe of the liver. A second window was made through the left thoracotomy and the defective area was sutured closed. About 2L of serous pleural fluid was drained as well.

Post-operatively, she tolerated low volumes of CCPD and was discharged with a prescription to advance dialysis as tolerated. One month later, she developed recurrent episode of SOB secondary to a left sided pleural effusion. A CT peritoneography was negative for peritoneal leakage. She transitioned to HD and her symptoms have since resolved.

Conclusion

This case of recurrent pericardial effusions in patient on PD emphasizes the need for the clinician to suspect a PPF especially with a history of multiple pericardial interventions.