A case of hydrothorax in peritoneal dialysis / 대한내과학회지

Continuous ambulatory peritoneal dialysis (CAPD) is an effective renal replacement therapy for the end stage renal disease. The hydrothorax secondary to leakage of dialysate via pleuroperitoneal communication is a rare complication of CAPD. A variety of symptoms are complained. The regular chest X-ray and pleural fluid examination are needed to find out this complication with vague symptoms. Although our understanding of its mechanisms is incomplete, it is apparent that the key to successful therapy is obliteration of a transdiaphragmatic route of dialysate leakage (pleuroperitoneal communication). Several treatments of CAPD-induced hydrothorax have included pleurodesis with tetracycline, talc, fibrin, or autologous blood and surgical treatment. We have recently managed with a patient CAPD-induced massive hydrothorax with decreased amount of effluent dialysate volumes using talc pleurodesis. This patient was successfully returned to CAPD.

A Case of Intramural Duodenal Hematoma Presenting with Acute Duodenal Obstruction

Intramural duodenal hematoma (IDH) is a quite rare disese entity which results from the collection of blood and body fluid between mucosa and serosa. Various degrees of duodenal obstruction may be caused by IDH as it gradually enlarges and compresses the mucosa against the opposite side of duodenum. The most common cause of IDH is blunt abdominal trauma and the spontaneous IDHs are generally casused by coagulation disorder such as blood dyscrasia, anticoagulation treatment or pancreaticoduodenal aneurysm. The diagnosis is usually made by the typical imaging on abdominal computed tomographic scan with a previous history of blunt abdominal trauma. For spontaneous IDH without coagulation disorder, an abdominal angiogram may be considered to exclude vascular anomalies. Medical treatment is recommended unless the associated visceral injuries require immediate laparotomy. Here, we report a case of acute duodenal obstruction due to IDH which had resolved completely without an operative management.