Cases reported "Peritoneal Diseases"

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1/16. Thoracoscopic surgery and pleurodesis for pleuroperitoneal communication in patients on continuous ambulatory peritoneal dialysis.

    Two patients on continuous ambulatory peritoneal dialysis (CAPD) developed right massive hydrothorax and were diagnosed as having pleuroperitoneal communication. Thoracoscopic surgery and pleurodesis were performed. It showed that one was caused by multiple flaws in the diaphragm and that the other was attributable to multiple blebs in the diaphragmatic dome. After the procedure, both of them had no recurrence of hydrothorax and underwent CAPD safely. We recommend thoracoscopic surgery and pleurodesis as the first choice of therapeutic methods for pleuroperitoneal communication.
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2/16. Bronchoperitoneal fistula secondary to chronic klebsiella pneumoniae subphrenic abscess.

    We treated a case of bronchoperitoneal fistula secondary to a klebsiella pneumoniae subphrenic abscess. This fistulous communication and the surgical procedure used to treat it are described.
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3/16. Management of a patient with hepatic-thoracic-pelvic and omental hydatid cysts and post-operative bilio-cutaneous fistula: a case report.

    In humans, most hydatid cysts occur in the liver and 75% of these are single. Our patient was a 31 year-old male. His magnetic resonance imaging (MR) showed one cyst (15 x 20 cm) in the right lobe and three cysts (5 x 6 cm, 8 x 6 cm, and 5 x 5 cm) in the left lobe of the liver, two cysts (4 x 5 cm and 5 x 5 cm) on the greater omentum, and two cysts (15 x 10 and 10 x 10 cm) in the pelvis. The abdomen was entered first by a bilateral subcostal incision and then by a Phennenstiel incision. Partial cystectomy capitonnage was done on the liver cysts; the cysts on the omentum were excised, and the pelvic cysts were enucleated. The cyst in the right lobe of the liver was in communication with a thoracic cyst. An air leak developed from the thoracic cyst which had underwater drainage and bile drainage from the drain in the cavity of the right lobe cyst. Sphincterotomy was done on the seventh post-operative day by endoscopic retrograde cholangiopancreatography (ERCP). No significant effect on mean bile output from the fistula occurred. octreotide therapy was initiated, but due to abdominal pain and gas bloating the patient felt and could not tolerate, it was stopped on the fourth day; besides, it had no decreasing effect on bile output during the 4 days. Because air and bile leak continued and he had bile stained sputum, he was operated on on post-operative day 18. By right thoracotomy, the cavity and the leaking branches were closed. By right subcostal incision, cholecystectomy and T-tube drainage of the choledochus were done. On post-operative day 30, he was sent home with the T-tube and the drain in the cavity. After 3 months post-operatively, a second T-tube cholangiography was done, and a narrowing in the distal right hepatic duct and a minimal narrowing in the distal left hepatic duct were exposed. Balloon dilatation was done by way of a T-tube. bile drainage ceased. There was no collection in the cavity in follow-up CT scanning, so the drain in the cavity, and the drainage catheter in the right hepatic duct were extracted. Evaluation of the biliary ductal system is important in bilio-cutaneous fistulas, and balloon dilatation is very effective in fistulas due to narrowing of the ducts.
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4/16. Sonographic diagnosis of a small fistulous communication between a subphrenic abscess and a perforated duodenal ulcer.

    We report a case of a fistula between a subphrenic abscess and a perforated duodenal ulcer diagnosed by sonography and confirmed by CT. The sonographic findings included a subphrenic fluid collection connected to the anterior aspect of the superior duodenum by a nonpulsatile, anechoic tubular lesion. Manual compression of the upper epigastrium resulted in movement of echogenic debris from the antrum and superior duodenum through the fistulous tract into the abscess.
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5/16. Congenital pleuroperitoneal communication in a patient with pseudomyxoma peritonei.

    BACKGROUND AND OBJECTIVES: pseudomyxoma peritonei syndrome is a rare disease arising from a perforated appendiceal adenoma. The syndrome is characterized by progressive accumulation of mucinous ascites and tumor within the peritoneal cavity. Direct extension of pseudomyxoma peritonei to the pleural cavity is uncommon and has been associated with surgical penetration of the diaphragm at the time of cytoreduction. methods: We review the case of a patient who presented with mucoid peritoneal and pleural fluid consistent with spontaneous pleural spread of pseudomyxoma peritonei. RESULTS: Surgical exploration confirmed direct pleuroperitoneal communication by macroscopic diaphragmatic fenestration. CONCLUSIONS: This is a rare phenomenon. We outline a therapeutic approach to be applied when pleural involvement is suspected in patients with pseudomyxoma peritonei syndrome.
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6/16. Diaphragmatic defect with peritoneopericardial communication.

    An 81-year-old man had a congenital defect of the central tendon of the diaphragm, including a peritoneopericardial communication with herniation of the omentum to the pericardial sac in front of the heart. In addition, he had a critically stenosed congenital bicuspid aortic valve and severe coronary artery disease. The patient underwent reduction of the herniated omentum into the abdominal cavity, coronary artery bypass grafting, aortic valve replacement, and closure of the peritoneopericardial communication with a synthetic patch. Three years later, the patient was doing well, with a normally functioning pericardial valve in the aortic position and no sign of omentum around the heart.
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7/16. Surgical treatment of massive hydrothorax complicating continuous ambulatory peritoneal dialysis.

    Acute hydrothorax is a well-recognized complication of continuous ambulatory peritoneal dialysis and is often regarded as a contraindication to its use. We report three cases treated by surgical closure of a communication between the peritoneal and pleural cavities enabling CAPD to continue successfully. This is a simple, safe and effective procedure which merits wider use as an alternative to transferring the patient to permanent hemodialysis.
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8/16. Pleuroperitoneal communication associated with malignant ascites. A potential cause for new pleural effusion suggestive of pulmonary embolism.

    A patient with metastatic gastric carcinoma and malignant ascites developed sudden-onset dyspnea secondary to a new large left pleural effusion. A radionuclide lung scan performed for suspected pulmonary embolism was indeterminate. Scintigraphy performed following intraperitoneal administration of Tc-99m sulfur colloid subsequently demonstrated rapid accumulation of activity in the left pleural space, indicating the presence of a pleuroperitoneal communication. In a patient with known or suspected ascites, a new pleural effusion, and an indeterminate lung scan, peritoneal scintigraphy may identify the origin of the effusion and obviate the need for further invasive evaluation for possible pulmonary embolism.
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9/16. A review of management of pleuroperitoneal communication in five CAPD patients.

    Development of massive hydrothorax is well known in CAPD patients. Five CAPD patients at one center have developed some form of pleuroperitoneal communication as evidenced by pleural effusion. Temporary discontinuation of CAPD, tetracycline instillation, and surgical patch grafting of the diaphragm have been used as treatments for the communication.
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10/16. Pleuroperitoneal communication in a patient with right pleural effusion and ascites diagnosed by technetium-99m sulfur colloid imaging.

    A 55-year-old man with an 11-year history of intermittent right pleural effusions had continued fevers and a large right transudative pleural effusion. Minimal ascites was noted by ultrasound examination. A communication between the thorax and intraperitoneal cavity was established by radionuclide examination of the chest and abdomen. Tc-99m sulfur colloid was injected into the peritoneal cavity, and imaging at 1 and 4.5 hours confirmed passage from the peritoneal to the pleural cavity. Repeated attempts to sclerose the pleural cavity failed to decrease the transudative accumulations. The patient was subsequently treated with the placement of a LeVeen shunt.
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