technetium-tc-99m-sulfur-colloid and Hernia--Inguinal

Continuous ambulatory peritoneal dialysis is a widely used and convenient alternative to haemodialysis in patients with renal failure. Occasionally, a scrotal swelling may develop during this procedure because of fluid passing through a patent processus vaginalis. We present a case report to illustrate the diagnostic use of radionuclide scintigraphy in this group of patients.

Topics: Aged; Hernia, Inguinal; Humans; Kidney Failure, Chronic; Male; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Radionuclide Imaging; Radiopharmaceuticals; Scrotum; Technetium Tc 99m Sulfur Colloid

Topics: Hernia, Inguinal; Humans; Hydrothorax; Male; Middle Aged; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

A variety of factors can adversely impact chronic peritoneal dialysis (CPD) as an effective renal replacement therapy for patients with end-stage renal disease. These factors include peritonitis, poor clearances, loss of ultrafiltration, and a variety of anatomic problems, such as hernias, peritoneal fluid leaks, loculations, and catheter-related problems caused by omental blockage. This study reviews our experience with peritoneal scintigraphy for the evaluation of some of these difficulties.. From 1991 to 1996, 50 peritoneal scintigraphy scans were obtained in 48 CPD patients. Indications for scintigraphy were evaluated, and the patients were placed into four groups: group I, abdominal wall swelling; group II, inguinal or genital swelling; group III, pleural fluid; and group IV, poor drainage and/or poor ultrafiltration. A peritoneal scintigraphy protocol was established and the radiotracer isotope that was used was 2.0 mCi of 99mtechnetium sulfur colloid placed in two liters of 2.5% dextrose peritoneal dialysis solution.. Ten scans were obtained to study abdominal wall swelling, with seven scans demonstrating leaks; six of these episodes improved with low-volume exchanges. Twenty scans were obtained to evaluate inguinal or genital swelling, and 10 of these had scintigraphic evidence for an inguinal hernia leak (9 of these were surgically corrected). One of four scans obtained to evaluate a pleural fluid collection demonstrated a peritoneal-pleural leak that corrected with a temporary discontinuation of CPD. Sixteen scans were obtained to assess poor drainage and/or ultrafiltration. Five of these scans demonstrated peritoneal location, and all of these patients required transfer to hemodialysis. The other 11 scans were normal; four patients underwent omentectomies, allowing three patients to continue with CPD.. Peritoneal scintigraphy is useful in the evaluation and assessment of CPD patients who develop anatomical problems (such as anterior abdominal, pleural-peritoneal, inguinal, and genital leaks) and problems with ultrafiltration and/or drainage.

Topics: Adult; Aged; Aged, 80 and over; Edema; Evaluation Studies as Topic; Female; Genitalia; Hernia, Inguinal; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Cavity; Peritoneal Dialysis; Pleura; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Dialysis Solutions; Hernia, Inguinal; Humans; Kidney Failure, Chronic; Male; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

The intraperitoneal instillation of dialysate increases intra-abdominal pressure and consequently predisposes to subcutaneous infiltration, leaks, and herniations through defects in the abdominal wall. In this setting, the incidence of abdominal hernias ranges between 9% and 24%. Life-threatening complications (incarceration/strangulation) occur in up to 13.2% of hernias. Therefore, the authors evaluated the efficacy of the Tc-99m sulfur colloid (SC) intraperitoneal scan in the detection of abdominal leaks and hernias in 11 continuous ambulatory peritoneal dialysis (CAPD) patients over a 2-year period at the Hospital of the University of Pennsylvania. Eleven patients (7M, 4F) ranging in age from 24 to 72 (mean = 50.8), on CAPD, were evaluated for clinically suspected abdominal hernias or dialysate leaks with intraperitoneally administered Tc-99m SC. After the injection of 3-5 mCi of Tc-99m into a standard 2 liter dialysate bag, multiple sequential anterior images of the abdomen were obtained in the supine position over the course of one hour. Delayed images were obtained after ambulation and post-drainage two or more hours postinjection in multiple projections and positions in order to demonstrate any abnormal focal accumulations of fluid to the best advantage. Any detected abnormalities were marked and correlated with the physical examination and the patient's symptoms. Two patients had normal scans. Of the nine abnormal scans, five hernias were identified in four patients and six leaks were detected in the other five patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Edema; Female; Hernia, Inguinal; Humans; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritoneal Diseases; Peritoneum; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

This retrospective analysis of 140 continuous ambulatory peritoneal dialysis patients followed during a 4 year period revealed a 5 percent incidence of abdominal wall hernias. Inguinal hernias were frequently manifested as unilateral scrotal swelling. Hernias too small to be appreciated by physical examination were easily demonstrable with intraperitoneal instillation of technetium 99m sulfur colloid through the continuous ambulatory peritoneal dialysis catheter. This procedure was also useful when differentiating dialysate leaks from inguinal hernia in the early and late postoperative periods. Recurrences developed in 27 percent of the herniorrhaphies. Factors contributing to the development of abdominal wall hernias in continuous ambulatory peritoneal dialysis patients include uremia, obesity, anemia, and chronically elevated intraperitoneal pressures.

Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Female; Hernia, Inguinal; Hernia, Ventral; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Radionuclide Imaging; Recurrence; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

Continuous ambulatory peritoneal dialysis (CAPD) is commonly used in patients with renal failure as an alternative to hemodialysis. A not infrequent complication is scrotal swelling due to bowel or fluid passing through a patent processus vaginalis secondary to increased abdominal pressure. A radionuclide study using Tc-99m sulfur colloid is a safe and simple method to determine if this complication is present or may be used as a pre-CAPD screening procedure.

Topics: Edema; Hernia, Inguinal; Humans; Male; Middle Aged; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Radionuclide Imaging; Scrotum; Technetium Tc 99m Sulfur Colloid