1. Nomoto Y, Suga T, Nakajima K, Sakai H, Osawa G, Ota K, et al. Acute hydrothorax in continuous ambulatory peritoneal dialysis—a collaborative study of 161 centers. am j nephrol 1989; 9:363–7. 2. Szeto CC, Chow KM. Pathogenesis and management of hydrothorax complicating peritoneal dialysis. Curr opin Pulm Med 2004; 10:315–19. 3. Chow CC, Sung JY, Cheung CK, Hamilton–Wood C, Lai KN. Massive hydrothorax in continuous ambulatory peritoneal dialysis: diagnosis, management and review of the literature. n Z Med j 1988; 101:475–7. 4. Kawaguchi AL, Dunn JC, Fonkalsrud EW. Management of peritoneal dialysis–induced hydrothorax in children. am Surg 1996; 62:820–4. 5. Lew SQ. Hydrothorax: pleural effusion associated with peritoneal dialysis. Perit Dial Int 2010; 30:13–18. 6. Yim AP, Lee TW, Wan IY, Ng C. Images in cardiothoracic surgery. Pleuroperitoneal fistula. ann Thorac Surg 2002; 73:1327. 7. Gagnon RF, Thirlweil M, Arzoumanian A, Mehio A. Systemic amyloidosis involving the diaphragm and acute massive hydrothorax during peritoneal dialysis. Clin nephrol 2002; 57:474–9. 8. Van Dijk CM, Ledesma SG, Teitelbaum I. Patient characteristics associated with defects of the peritoneal cavity boundary. Perit Dial Int 2005; 25:367–73. 9. Saillen P, Mosimann F, Wauters JP. Hydrothorax and endstage chronic renal failure. Chest 1991; 99:1010–1. 10. Chow KM, Szeto CC, Wong TY, Li PK. Hydrothorax complicating peritoneal dialysis: diagnostic value of glucose concentration in pleural fluid aspirate. Perit Dial Int 2002; 22:525–8. 11. Juergensen PH, Rizvi H, Caride VJ, Kliger AS, Finkelstein FO. Value of scintigraphy in chronic peritoneal dialysis patients. Kidney Int 1999; 55:1111–19. 12. Mestas D, Wauquier JP, Escande G, Baguet JC, Veyr A. Diagnosis of hydrothorax complicating CAPD and demonstration of successful therapy by scintigraphy. Perit Dial Int 1991; 11:283–4. 13. Cho Y, D’Intini V, Ranganathan D. Acute hydrothorax complicating peritoneal dialysis: a case report. j Med Case rep 2010; 4:355. 14. Tang S, Chui WH, Tang AW, Li FK, Chau WS, Ho YW, et al. Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis. nephrol Dial Transplant 2003; 18:804–8. 15. Kechrid MC, Malik GH, Shaikh JF, Al-Mohaya S, Al-Wakeel JS, El Gamal H. Acute hydrothorax complicating continuous ambulatory peritoneal dialysis: a case report and review of literature. Saudi j Kidney Dis Transpl 1999; 10:163–6. 16. Chow KM, Szeto CC, Li PK. Management options for hydrothorax complicating peritoneal dialysis. Semin Dial 2003; 16:389–94. 17. Gibbons GD, Baumert J. Unilateral hydrothorax complicating peritoneal dialysis. Use of radionuclide imaging. Clin nucl Med 1983; 8:83–4. 18. Rajnish A, Ahmad M, Kumar P. Peritoneal scintigraphy in the diagnosis of complications associated with continuous ambulatory peritoneal dialysis. Clin nucl Med 2003; 28:70–1. 19. Pankaj P, Pathak V, Sen IB, Verma R, Bhalla AK, Marwaha A, et al. Use of radionuclide peritoneography in the diagnosis of pleuroperitoneal communication as a complication of continuous ambulatory peritoneal dialysis. Ind j nucl Med 2005; 20:4–8. 20. Goh AS, Lee GS, Kee SG, Ang ES, Sundram FX. Radionuclide detection of dialysate leakage in patients on continuous ambulatory peritoneal dialysis. ann acad Med Singapore 1994; 23:315–18. 21. Huang JJ, Wu JS, Chi WC, Lan RR, Yang LF, Chiu NT. Hydrothorax in continuous ambulatory peritoneal dialysis: therapeutic implications of Tc-99m MAA peritoneal scintigraphy. nephrol Dial Transplant 1999; 14:992–7. 22. Krishnan RG, Ognjanovic MV, Crosier J, Coulthard MG. Acute hydrothorax complicating peritoneal dialysis. Perit Dial Int 2007; 27:296–9. doi:10.3747/pdi.2012.00077

Intestinal obstruction--an unusual complication of peritoneoscopic Tenckhoff catheter insertion.

CASE HISTORY The patient was a 20-year-old Munyankole from western Uganda, who was admitted as an emergency with colicky abdominal pain, vomiting and constipation for 2 days. He had been in good health until 4 months previously, when he was admitted elsewhere with an attack of severe abdominal pain which settled on conservative treatment. He had not had any operations in the past and was not on any medication. On examination there was a smooth, round, tender mass in the L lower abdomen, resembling an ovarian cyst. Sigmoidoscopy, performed on suspicion of sigmoid volvulus, was normal. At laparotomy the mass appeared to consist of loops of small bowel (approximately the distal 2/3) wrapped together in a sleeve-like cocoon. This was quite thin proximally, becoming progressively thicker and tougher distally. It ended lOcm before the ileocoecal junction. The distal part of the small bowel inside the cocoon was linked very tightly in a concertina-like fashion and the last 50em was gangrenous. Freeing the mass from the pelvis was difficult. Once this had been achieved, the remainder of the operation consisted of peeling off as much as possible of the cocoon, freeing and straightening of the small bowel and resection of the gangrenous part of ileum with an endto-end anastomosis. Postoperative recovery was uneventful.

Idiopathic abdominal cocoons ... not just for girls.

Small bowel obstruction secondary to recurrent peritonitis. A fatal complication of chronic ambulatory peritoneal dialysis.

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Small bowel obstruction secondary to recurrent peritonitis. A fatal complication of chronic ambulatory peritoneal dialysis.