Methylene Blue Instillation: A Cost-Effective Diagnostic Approach for Pleuroperitoneal Fistula in Resource-Limited Settings

A pleuroperitoneal fistula, an uncommon complication of peritoneal dialysis, involves a connection between the peritoneal cavity and the pleural space. This case highlights a cost-effective diagnostic option for detecting these fistulas in primary care hospitals and emphasizes the importance of considering this condition in patients with a history of peritoneal dialysis and persistent pleural effusion. We present a case of a 55-year-old female patient undergoing peritoneal dialysis for end-stage renal disease who developed a pleuroperitoneal fistula, leading to persistent pleural effusion. This condition was successfully diagnosed using methylene blue instillation into the dialysis bags, demonstrating a potentially viable diagnostic technique that is effective, safe, and cost-efficient for primary and secondary care hospitals. The presented case underscores that pleural effusion, as a complication with high mortality, should be considered in any patient with end-stage renal disease presenting with dyspnea, desaturation, and pleuritic pain secondary to peritoneal dialysis sessions. Furthermore, the use of methylene blue is proposed as a cost-effective and accessible diagnostic alternative. This approach not only facilitates accurate diagnosis but also simplifies the diagnostic process without relying on advanced imaging technologies that might not be available.