Advertisment

Indian Journal of Nephrology About us |  Subscription |  e-Alerts  | Feedback | Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Current Issue | Archives| Ahead of print | Search |Instructions |  Editorial Board  

Users Online:526

Official publication of the Indian Society of Nephrology
  Search
 
  
 ~  Similar in PUBMED
 ~  Search Pubmed for
 ~  Search in Google Scholar for
 ~  Article in PDF (1,056 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
   References
   Article Figures

 Article Access Statistics
    Viewed1966    
    Printed26    
    Emailed1    
    PDF Downloaded55    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
LETTER TO EDITOR
Year : 2014  |  Volume : 24  |  Issue : 4  |  Page : 265-266
 

Spontaneous pneumomediastinum and subcutaneous emphysema in continuous ambulatory peritoneal dialysis patient


Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 1121, Saudi Arabia

Date of Web Publication30-Dec-2013

Correspondence Address:
Q Nadri
Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 1121
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.133052

Rights and Permissions



How to cite this article:
Nadri Q. Spontaneous pneumomediastinum and subcutaneous emphysema in continuous ambulatory peritoneal dialysis patient. Indian J Nephrol 2014;24:265-6

How to cite this URL:
Nadri Q. Spontaneous pneumomediastinum and subcutaneous emphysema in continuous ambulatory peritoneal dialysis patient. Indian J Nephrol [serial online] 2014 [cited 2021 Nov 30];24:265-6. Available from: https://www.indianjnephrol.org/text.asp?2014/24/4/265/133052


Sir,

Peritoneal dialysis (PD) has been a successful modality in patients with end-stage renal disease (ESRD). Besides its usual complications such as infection, hernias, genital edema and Tenchoff catheter related mechanical problems, rare complications such as pneumoperitoneum, subcutaneous emphysema (SE) and pneumomediastinum in continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) patients have been reported. [1],[2],[3]

A 29-year-old female patient with ESRD from systemic lupus erythematous on CAPD for 1½ year presented to emergency with 2 days history of fatigue, Shortness of breath, chest pain radiating to back and vomiting. Denied fever and abdominal pain. Patient was hypotensive, dyspneic and dehydrated. Subcutaneous crepitation felt over upper chest and neck. Chest exam revealed decreased breath sound and scattered crackles all over the chest on auscultation. Abdomen was soft non-tender. Chest X-ray showed SE, bilateral pneumothorax and pnemomediastinum [Figure 1]. This was confirmed by computed tomography (CT) chest. With a history of vomiting, CT ruled out esophageal perforation. Gastrograffin swallow study showed no esophageal leak. There was no sign of peritonitis and PD fluid was clear. Patient was resuscitated with intravenous fluids with restoration of hemodynamic and maintained on oxygen therapy. Patient did not require mechanical ventilation and chest tube insertion. On conservative management under intensive care unit, symptoms, oxygenation and chest X-ray improved over 3 days. Patient continued on CAPD and discharged in stable condition after 6 days.
Figure 1: Chest X - ray showing subcutaneous emphysema (upper arrow) pneumomediastinum and pneumothorax (middle arrow) and gastrografin in stomach (lower arrow)

Click here to view


In this case no peritoneal complication such as peritonitis or PD catheter related problem occurred. Previous reports [1],[2],[3] described in CAPD and APD patients were associated with either translocation of Tenckhoff catheter to the retroperitoneal cavity with hematoma or was associated with faulty dialysis technique. Spontaneous pneumomediastinum and SE has several etiologies; asthma, chronic obstructive pulmonary disease, forced vomiting, esophageal rupture. Spontaneous pneumomediastinum is not associated with blunt force or penetrating chest trauma, endobronchial or esophageal procedures, mechanical ventilation, chest surgery or other invasive procedures. The development of SE and pneumomediastinum in this patient may had been resulted from esophageal rupture after vomiting with spontaneous seal called Boerhaave syndrome (esophageal rupture following vomiting). Contrast CT ruled out esophageal perforation in this case. There was no pnemoperitonum which ruled out abdominal causes such as bowel perforation, nor did the patient undergo a new PD catheter insertion, as reported in previous cases. Interestingly in all cases SE and pneumomediastinum resolved within few days on conservative management and adequacy of PD was maintained without recurrence.

This case attempts to highlights the importance of awareness of such rare condition in PD patient.

 
  References Top

1.Zbroch E, Malyszko J, Kamocki Z, Myśliwiec M. Pneumomediastinum and subcutaneous emphysema - Unusual complications of automated peritoneal dialysis. Perit Dial Int 2003;23:97-8.  Back to cited text no. 1
    
2.Cancarini GC, Manili L, Cristinelli MR, Bracchi M, Carli O, Maiorca R. Pneumoperitoneum and pneumomediastinum in a CAPD patient with peritonitis. Perit Dial Int 1997;17:389-91.  Back to cited text no. 2
    
3.Halland M, May S. An unusual complication of peritoneal dialysis catheter insertion. Nephrology (Carlton) 2008;13:357-8.  Back to cited text no. 3
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
 

    

Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07