Pericardial Dialysate Leakage in a Peritoneal Dialysis Patient

Pericardial dialysate leakage in peritoneal dialysis patients is a rare but serious complication. Increase in intraabdominal pressure, peritonitis, adhesion due to abdominal procedures, and cardiac and pericardial procedures are the risk factors for leakage.

A 12-year-old girl undergoing peritoneal dialysis treatment for four years due to nephronophtisisassociated end-stage renal disease presented with epigastric pain and dyspnea 3 days after the completion of the treatment of the third peritonitis attack. Physical examination revealed epigastric tenderness and decreased heart sounds. Massive pericardial effusion was detected and 500 ml fluid was obtained by pericardial drainage. Peritoneal dialysis was attempted, but when dialysate was given to the peritoneum, all the fluid passed through to the pericardial drain. She was switched to a hemodialysis program. Two months later she underwent a renal transplantation. She has been followed up for 12 months.

Magnetic resonance imaging or dynamic scintigraphy can be used to show pericardial dialysate leakage on peritoneal dialysis patients. We could not use these imaging modalities because of the patient’s poor general health. However, the diagnosis was evident by direct observation of dialysate leakage through the pericardial drain after its insertion. In conclusion, peritoneo-pericardial leak should be considered when pericardial effusion is detected in patients undergoing peritoneal dialysis.