Original Article
Peritoneal scintigraphy and SPECT/TC in the diagnosis of leaks in patients on peritoneal dialysis
Gammagrafía peritoneal y SPECT/TC en el diagnóstico de fugas en pacientes en diálisis peritoneal
D. Tercero Garridoa,b,
, M.V. Guiote Morenoa,b, C. Rodelo-Haadb,c, P.I. Contreras Puertasa, S. Soriano Cabrerab,c, M.D. Albalá Gonzáleza,b
Corresponding author
a Unidad de Gestión Clínica de Medicina Nuclear, Hospital Universitario Reina Sofía, 14004, Córdoba, Spain
b Instituto Maimónides de Investigación Biomédica (IMIBIC), Universidad de Córdoba, 14004, Córdoba, Spain
c Unidad de Gestión Clínica de Nefrología, Hospital Universitario Reina Sofía, 14004, Córdoba, Spain
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Tercero Garrido, M.V. Guiote Moreno, C. Rodelo-Haad, P.I. Contreras Puertas, S. Soriano Cabrera, M.D. Albalá González" "autores" => array:6 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Tercero Garrido" "email" => array:1 [ 0 => "desiree.tercero.sspa@juntadeandalucia.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.V." "apellidos" => "Guiote Moreno" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C." 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"apellidos" => "Soriano Cabrera" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "M.D." "apellidos" => "Albalá González" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Medicina Nuclear, Hospital Universitario Reina Sofía, 14004, Córdoba, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto Maimónides de Investigación Biomédica (IMIBIC), Universidad de Córdoba, 14004, Córdoba, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Nefrología, Hospital Universitario Reina Sofía, 14004, Córdoba, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Gammagrafía peritoneal y SPECT/TC en el diagnóstico de fugas en pacientes en diálisis peritoneal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1409 "Ancho" => 3417 "Tamanyo" => 266245 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Scintigraphic study (early, delayed and post-emptying images of abdominal-pelvic region) and SPECT/CT compatible with leakage of peritoneal dialysis fluid toward a right inguinal hernia and reaching the scrotal region (red arrow in the scintigraphic study and blue arrow in the SPECT/CT).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic kidney disease (CKD) is a health problem worldwide.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The techniques of renal replacement therapy can reduce the associated complications, improve quality of life of patients in terminal stages and reduce mortality.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Several treatment options are available, including renal replacement treatment with peritoneal dialysis, hemodialysis or kidney transplantation.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Peritoneal dialysis consists in a procedure of partial replacement of renal function, purifying solutes and electrolytes using the peritoneum as a membrane of filtration and exchange.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Peritoneal dialysis can prolong and improve the quality of life of the patients and allow greater autonomy. Nonetheless, it is not free of complications. Peritoneal leaks may appear at different times after the implementation of the technique and their manifestations are determined by the site of pericatheter, pleural cavity, retroperitoneal or inguinal peritoneal fluid leakage.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Early diagnosis is important to solve this complication given the impact this technique has on the quality of life and survival of patients.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> There are different imaging tests for the diagnosis of complications, such as simple radiography of the abdomen and chest, scintigraphy, computerized tomography (CT) and magnetic resonance (MR). Scintigraphy has a series of advantages given that it is non-invasive, low cost and avoids the use of contrasts.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> In doubtful cases, the scintigraphy study may be complemented with the acquisition of single photon emission computed tomography (SPECT)/CT which increases its sensitivity and specificity.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> However, literature on the use of peritoneal scintigraphy and SPECT/CT for the study of leaks in patients on peritoneal dialysis is scarce, and is, thus, the objective of the present study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Descriptive case series</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study was performed with the aim of evaluating the utility of peritoneal cavity scintigraphy and the contribution of SPECT/CT in patients on peritoneal dialysis with suspicion of leakage. This was a longitudinal, descriptive, retrospective, observational case series study.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study population included patients receiving peritoneal dialysis with symptomatology of suspected leakage in a third level hospital from October 1, 2020 to August 1, 2023.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Abdominal scintigraphy was performed in all the patients in supine and Trendelemburg position to facilitate intraperitoneal distribution of the infusion of 185 MBq (5 mCi) of [<span class="elsevierStyleSup">99m</span>Tc] Tc-albumin nanocolloid in 1.5−2 L of peritoneal dialysis fluid. The infusion was performed according to the institutional protocol of the Hospital Reina Sofía of Córdoba, Spain, with different parameters, such as volume and time, being adapted to the characteristics of each patient.</p><p id="par0040" class="elsevierStylePara elsevierViewall">With the patient supine, planar images of the thorax and abdomen were acquired at 15 min and 2 h after radiotracer infusion and immediately after peritoneal drainage in anterior, posterior, right and left laterals of the thorax (above the diaphragmatic dome) and anterior and posterior of the abdomen and pelvis (to the testicles in men and the vulva in women). Finally, a hybrid SPECT/CT tomographic study without intravenous or oral contrast was performed at 15 min after drainage.</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Inclusion criteria:</span><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">Patients receiving peritoneal dialysis treatment with suspicion of leakage based on the symptomatology in the Hospital Universitario Reina Sofía de Córdoba.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0055" class="elsevierStylePara elsevierViewall">Patients who underwent scintigraphy of the peritoneal cavity and SPECT/CT study.</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Exclusion criteria:</span><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">Images not fulfilling the criteria of quality for diagnostic analysis.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">Lack of documented patient follow-up.</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data collection</span><p id="par0075" class="elsevierStylePara elsevierViewall">Analysis of the reports available in the electronic clinical history was performed, registering the following information: age, sex, clinical presentation (symptomatology suggestive of peritoneal leakage), change in therapeutic management, evolution and survival.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The findings of the imaging tests of each patient were reviewed and the following data were collected: presence of peritoneal leakage, visualization of the image pre- and post-drainage of the dialysis fluid, localization of peritoneal leak, and comparison of planar and SPECT/CT images.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The data were anonymized for patient confidentiality according to Organic Law 3/2018 of 5 December, on the Protection of Personal Data and the Guarantee of Digital Rights.</p><p id="par0090" class="elsevierStylePara elsevierViewall">We obtained the data of all the patients who underwent the previously mentioned study from October 1, 2020 to August 1, 2023 and fulfilled the inclusion criteria.</p><p id="par0095" class="elsevierStylePara elsevierViewall">It is of note that among the scarce literature available, the number of patients described varied between 1 in clinical case reports to 48 in the study by Juergensen et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall">The descriptive statistical analysis was performed with Microsoft Excel. Quantitative variables are shown as mean and standard deviation (SD) and the qualitative variables as frequencies and percentages.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The Ethical Committee of Clinical Investigation of Cordoba approved the study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sociodemographic and general characteristics</span><p id="par0110" class="elsevierStylePara elsevierViewall">A total of 11 patients (6 women and 5 men) with a mean age (±SD) of 66 ± 4 years were included in the study.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The most frequent causes of CKD in these patients were diabetes/hypertension and glomerulonephritis. Among the four patients with glomerulonephritis, three presented focal and segmentary glomerulonephritis and the remaining patient had CKD secondary to thin basement membrane disease.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The time from the day of dialysis catheter placement and the day of the Nuclear Medicine study was a mean (±SD) of 17.8 ± 5.5 months (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Clinical manifestations and diagnosis</span><p id="par0125" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the frequency of the different types of symptomatology justifying the clinical suspicion of peritoneal leak. Only two patients reported pain; at a suprapubic level in 1 and in the left hypochondrium in the other. Two patients presented left pleural effusion and one had right pleural effusion. As a symptom, genital edema was only presented by male patients, affecting 80% of those included in the study.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Likewise, 6 patients (54.5%) presented a positive study for peritoneal leakage, 4 being females and 2 males. The most frequent localizations of leakage were the abdominal wall at the catheter entry site and inguinal hernia. It was of note that in all the positive studies the uptake was more intense in the images obtained after drainage of the peritoneal dialysate than in the early images.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The last section of <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the frequency of leakage based on the type of symptomatology, being maximum in pain and in cellulitis of the subcutaneous route of the catheter. Likewise, 3 cases presented pleural effusion; however, the patient with pleural effusion localized in the right hemithorax showed the presence of peritoneal leakage while in the other 2 cases with pleural effusion localized in the left hemithorax, the study was negative.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In the patients with a negative scintigraphic study, leakage was not observed in any case in the SPECT/CT study and in patients with a positive planar image, all the cases were confirmed in the SPECT/CT study. Notably, in one doubtful positive case in the planar study, the SPECT/CT identified leakage at the level of catheter entry, providing greater sensitivity in the diagnosis.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In regard to the positive cases observed in the planar image, from a qualitative point of view, the localization of leakage was more accurate with SPECT/CT in 37.5% of the total leaks detected and in 75% of those localized at the catheter entry site and supraumbilical hernia (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Evolution</span><p id="par0150" class="elsevierStylePara elsevierViewall">We reviewed the evolution of the patients after undergoing scintigraphy of the peritoneal cavity with the aim of evaluating the change in therapeutic management.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Among the 6 patients diagnosed with leakage, in 2 it was decided to reduce the volume of infusion and in the remaining patients the technique was temporarily suspended, varying the interval of rest to between 2 and 8 weeks. After this initial measure, the modality of continuous outpatient peritoneal dialysis to automatic peritoneal dialysis was changed in 3 patients—1 patient was transplanted at 2 months after the diagnosis of leakage, another patient decided to receive hemodialysis and the third patient remained stable with a reduction in infusion volume.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Of the 5 patients with a negative diagnosis of peritoneal leakage, no relevant changes were made in the initial dialysis schedule. All showed clinical improvement, except 1 case with an unfavorable evolution. In this latter case, the study was repeated with a negative result, effusion continued and seemed to be related to pneumonia, and finally it was decided to change to hemodialysis.</p><p id="par0165" class="elsevierStylePara elsevierViewall">At the end of the data collection period (August 1, 2023), none of the patients had died.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0170" class="elsevierStylePara elsevierViewall">Peritoneal dialysis is a therapeutic option in patients with terminal CKD. This treatment is preferred over hemodialysis in certain cases, such as those with difficult vascular access or in patients with cardiovascular problems, and also allows greater patient autonomy.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Peritoneal leak occurs in 5–10% of the patients treated with peritoneal dialysis and is produced by an increase in intraabdominal pressure induced by dialysis volume.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> A series of factors may predispose this complication, such as congenital or acquired defects, for example, previous abdominal surgery.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,20</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">There is currently little literature regarding the use of scintigraphy of the peritoneal cavity and SPECT/CT. The results of the present study were compared with those of two of the most relevant studies in this area—one by Juergensen et al. which included 48 patients<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and another by Tokmak et al. including 17 patients.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">The present study included a total of 11 patients; 5 men (45.5%) and 6 women (54.5%) with a mean age of 66 ± 4 years and the time of dialysis until the study was 17.8 ± 5.5 months. The study by Juergensen et al. included 27 men (56.3%) and 21 women (43.7%) with a mean age of 60 ± 15.3 years and dialysis time of 23.8 ± 29.8 months while the study by Tokmak et al. included 8 men (47.1%) and 9 women (52.9%) with a mean age of 42.26 years and mean dialysis duration of 25.5 months.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Image acquisition was similar in the three studies, with early, delayed and post-emptying images, except that the study of Juergensen included a dynamic image during the infusion phase. In contrast to our study, neither that of Tokmak et al. or that of Juergensen et al. performed a SPECT/CT study.</p><p id="par0195" class="elsevierStylePara elsevierViewall">In the present study 2 patients who presented penile and scrotal edema were positive (33.3%), as was 1 patient of those with pleura effusion (16.7%) and 1 patient among those with cellulitis (16.7%). In the study by Juergensen et al., 50% of those presenting edema were positive, as were 25% of those with pleural effusion and 70% of those presenting swelling of the abdominal wall. On comparison with the Tokmak et al. study, it was found that 40% of the patients with genital/inguinal inflammation, 0% of those with pleural effusion and 80% of the patients presenting swelling of the abdominal wall were positive.</p><p id="par0200" class="elsevierStylePara elsevierViewall">A positive study result depending on the symptomatology was different among the studies, possibly due to the variability of the clinical manifestations and the sample size. Nonetheless, penile and scrotal edema is the subtype presenting the most stable percentage, varying from 33% to 50% among the studies.</p><p id="par0205" class="elsevierStylePara elsevierViewall">In regard to the change in therapeutic management, this study coincides with that of Juergensen et al., with several of their patients improving with low volume changes.</p><p id="par0210" class="elsevierStylePara elsevierViewall">There was concordance in that peritoneal scintigraphy is an effective technique for adequate diagnosis of peritoneal leakage, allowing relevant clinical improvement with a change in therapeutic approach in positive patients.</p><p id="par0215" class="elsevierStylePara elsevierViewall">Likewise, in doubtful cases, the acquisition of SPECT/CT increased the sensitivity and specificity of the diagnosis and allowed more accurate localization of the area of leakage. This was also demonstrated in the study by Álvarez Mena et al., who reported a clinical case of an 80-year-old male with CKD on peritoneal dialysis and presented pleural effusion. The presence of pleuroperitoneal communication was diagnosed and the addition of the SPECT/CT study allowed identification of the exact localization of the zone causing this communication, thereby facilitating a surgical approach if necessary.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Limitations</span><p id="par0220" class="elsevierStylePara elsevierViewall">As a limitation of this study, it should be noted that the studies were performed with different gamma cameras and given the differences in the characteristics of sensitivity and spatial resolution, the inherent variability these may induce should be taken into account. Likewise, there are also limitations in relation to the retrospective design of the study and the limited number of patients included in the study.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0225" class="elsevierStylePara elsevierViewall">Peritoneal scintigraphy, including the SPECT/CT study, is a non-invasive technique for the diagnosis of suspected peritoneal dialysate leakage in patients undergoing peritoneal dialysis. It allows the selection of patients who may benefit from a change in therapeutic management to palliate the symptomatology.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare that they received no specific funding from the public, commercial or not-for-profit sector or any other financial interests.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interests</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2270270" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1892784" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2270271" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodología" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1892783" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Descriptive case series" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Data collection" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data analysis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Sociodemographic and general characteristics" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Clinical manifestations and diagnosis" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Evolution" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Limitations" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-08-02" "fechaAceptado" => "2024-09-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1892784" "palabras" => array:5 [ 0 => "Scintigraphy" 1 => "CT SPECT" 2 => "Peritoneal leak" 3 => "Peritoneal dialysis" 4 => "[<span class="elsevierStyleSup">99m</span>Tc] Tc-albumin nanocolloids" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1892783" "palabras" => array:5 [ 0 => "Gammagrafía" 1 => "SPECT-CT" 2 => "Fuga peritoneal" 3 => "Diálisis peritoneal" 4 => "[99mTc] Tc-nanocoloides de albúmina" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To assess the usefulness of peritoneal cavity scintigraphy and the contribution of SPECT/CT in patients on peritoneal dialysis with suspected leak.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methodology</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">An observational case series study is carried out. It consists of a longitudinal, retrospective and descriptive study. 11 patients on peritoneal dialysis were studied and it was realiced a peritoneal cavity scintigraphy test and SPECT/CT to evaluate a peritoneal leak.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">In 54,5% of the patients, a positive study of peritoneal leak was obtained. The most frequent localitations were in the abdominal wall at the catheter entry level and the inguinal hernia. In the cases with sintomatology like pain and celullitis of the subcutaneous tract of the cateter the frequent of leak was 100%. There was a change in therapeutic management in patients with a positive study. There was not relevant changes in initial dialysis regimen in patients with a negative study. In this cases, except for one patient who required hemodialysis, all patients experienced clinical improvement.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Peritoneal scintigraphy and SPECT/CT study are non-invasive techniques that allow an adequate diagnosis and subsequent management of peritoneal leak.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Valorar la utilidad de la gammagrafía de cavidad peritoneal y la aportación del SPECT/CT en pacientes en diálisis peritoneal con sospecha de fuga.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Metodología</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se realiza un estudio observacional serie de casos. Consiste en un estudio longitudinal, retrospectivo y descriptivo en el cual se estudian 11 pacientes en diálisis peritoneal, que se realizaron gammagrafía de cavidad peritoneal y SPECT/CT por sospecha de fuga.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">En el 54,5% de los pacientes se obtuvo estudio positivo de fuga peritoneal, cuyas localizaciones más frecuentes se encuentran en pared abdominal a nivel de entrada de catéter y en hernia inguinal. En los pacientes con dolor y celulitis del trayecto subcutáneo del catéter se visualizó con más frecuencia fuga en la gammagrafía.</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">En los pacientes con estudio positivo hubo un cambio en el manejo terapéutico. En los pacientes con estudio negativo no se hicieron cambios relevantes en la pauta de diálisis inicial, con mejoría clínica en todos ellos, salvo un caso que requirió hemodiálisis.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">La gammagrafía peritoneal y el estudio SPECT/CT son técnicas no invasivas que permiten un adecuado diagnóstico y posterior manejo de fuga peritoneal.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodología" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:7 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1363 "Ancho" => 3417 "Tamanyo" => 257078 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scintigraphic study (early, delayed and post-emptying images of abdominal-pelvic region) and SPECT/CT compatible with leakage of peritoneal fluid to the abdominal wall, surrounding the catheter entry site, in the right iliac fossa (red arrow in the scintigraphic study and blue arrow in the SPECT/CT study).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1745 "Ancho" => 3417 "Tamanyo" => 334414 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">SPECT/CT study compatible with peritoneal leak showing key images indicative of the passage of the radiopharmaceutical to a supraumbilical hernia (blue arrow). Leakage toward the abdominal wall at the dialysis catheter entry level (red arrow) and to a right inguinal hernia (green arrow) as we can see in the maximum intensity projection (MIP) from a posterior perspective.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1409 "Ancho" => 3417 "Tamanyo" => 266245 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Scintigraphic study (early, delayed and post-emptying images of abdominal-pelvic region) and SPECT/CT compatible with leakage of peritoneal dialysis fluid toward a right inguinal hernia and reaching the scrotal region (red arrow in the scintigraphic study and blue arrow in the SPECT/CT).</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1860 "Ancho" => 3417 "Tamanyo" => 222853 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Scintigraphic study (early, delayed and post-emptying images of thoracic region) indicative of leakage of peritoneal fluid to right hemithorax (red arrow in anterior image and blue arrow in posterior image).</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">ADPKD: autosomal dominant polycystic kidney disease.</p>" "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sociodemographic and general characteristics of the patients studied</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (45.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (54.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 ± 4 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time on dialysis prior to the scintigraphic study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.8 ± 5.5 months \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3687639.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cause of chronic kidney disease</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-filiated origin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (18.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes/Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (36.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ADPKD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (9.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glomerulonephritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (36.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3687643.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic and general characteristics of the study population.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:4 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of symptomatology</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (18.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cellutis of the subcutaneous route of the catheter</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (18.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pleural effusion</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (27.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Genital edema</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Men: scrotal and penile edema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (80%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Women: vulvar edema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3687642.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Presence of peritoneal leak</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (54.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (45.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3687644.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localization of peritoneal leak</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdominal wall at the level of catheter entry (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (27.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Supraumbilical hernia (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inguinal hernia (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (27.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right hemithorax (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left hemithorax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3687641.png" ] ] 3 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Presence of peritoneal leak based on symptomatology \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Edema of the penis and scrotum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (50%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cellulitis along the subcutaneous route of the catheter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pleural effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3687638.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Results of peritoneal cavity scintigraphy in the present descriptive case series. Total <span class="elsevierStyleItalic">N</span> = 11.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Location of positive leak \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of leaks detected \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Accurate localization with planar image \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Accurate localization with SPECT/CT \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdominal wall at the catheter entry site \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (33.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Supraumbilical hernia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inguinal hernia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemithorax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Total</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (62.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3687640.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Contribution of SPECT/CT as a complementary study to planar scintigraphy in the localization of peritoneal leakages.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Information and consensus document for the detection and management of chronic kidney disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. 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