Discover the intricate challenges and innovative solutions in treating a peritoneal dialysis patient with a rare left pleuroperitoneal communication due to a pericardial defect post-coronary artery bypass surgery.
– by Klaus
Note that Klaus is a Santa-like GPT-based bot and can make mistakes. Consider checking important information (e.g. using the DOI) before completely relying on it.
A case of a peritoneal dialysis patient with left pleuroperitoneal communication caused by a pericardial defect after coronary artery bypass surgery.
Nakamura et al., CEN Case Rep 2024
<!– DOI: 10.1007/s13730-024-00867-1 //–>
https://doi.org/10.1007/s13730-024-00867-1
Once upon a chilly winter’s eve, in a tale not so merry and bright, we meet a 74-year-old lady, not unlike Mrs. Claus herself, if Mrs. Claus had been dealing with a sleigh-load of health issues. This lady, with a heart and kidneys not as sprightly as they once were, and a history of tinkering under the hood—coronary artery bypass surgery, to be precise—found herself short of breath, much like Santa after climbing up a particularly steep roof.
Our story takes a twist when, after starting peritoneal dialysis (PD), akin to Santa checking his list twice, an unexpected guest arrived: an increase in the left pleural effusion, much like unexpected snowfall on Christmas Eve. A diagnosis of left pleuroperitoneal communication was made, a bit like finding a hidden chimney passage, but far less jolly. Despite a thorough search under thoracoscopic observation—Santa’s elves with their tools couldn’t have done better—a 10 mm-sized hole in the pericardium was discovered, revealing a leak of ICG-loaded peritoneal dialysate fluid (PDF), much like finding where the elves hid the extra candy canes.
A CT peritoneography, using PDF mixed with a bit of iodine contrast medium, was like using Rudolph’s red nose to guide the way, revealing a defective pathway from the gastroepiploic artery to the right coronary artery, a path not even Santa’s reindeer could navigate. It was concluded that the left pleuroperitoneal communication was caused by a two-stage fistulous pathway, a bit like a secret tunnel from the workshop to the reindeer barn, but through the pericardial cavity after coronary artery bypass graft surgery.
Although the logical step would have been to close the diaphragmatic hole around the gastroepiploic artery graft, much like patching up a hole in Santa’s sack to prevent toy loss, the patient chose not to undergo further invasive procedures, preferring to keep her chimney closed for the season. Identifying the fistulous pathway proved as crucial as knowing which cookies Santa prefers, for the prompt diagnosis and treatment of pleuroperitoneal communication.
And so, our story concludes, not with a “Ho Ho Ho,” but with a reminder of the importance of thorough investigation and the choices we make, much like deciding which cookies to leave out for Santa on Christmas Eve.