Medical College of Ohio Department of Medicine Toledo USA Email: prao{at}mco.edu
Sir,
The case reported by Herbrig et al. [1] illustrates a very interesting teaching point. However, we have one objection to the initial method employed by the authors to demonstrate the leak. They have used methylene blue. This has been reported to be an irritant to the peritoneum, and would thus not be advisable to use it [2,3]. The estimation of glucose in the effusion with imaging by MRI would have sufficed to demonstrate the leak. In patients on peritoneal dialysis, every attempt should be made to preserve the peritoneum; avoiding exposure to methylene blue is one of them.
Conflict of interest statement. None declared.
References