A case of perforative peritonitis caused by a piece of bamboo in a patient on peritoneal dialysis

Suzuki, Yoshio; Mizuno, Masashi; Nakashima, Ryoko; Hiramatsu, Hideki; Toda, Susumu; Sato, Waichi; Tsuboi, Naotake; Ito, Isao; Maruyama, Shoichi; Imai, Enyu; Matsuo, Seiichi; Ito, Yasuhiko

doi:10.1007/s10157-011-0529-7

Cited by 7 publications

(8 citation statements)

References 18 publications

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“…In the ISPD guidelines, anaerobic growth is frequently linked to intra-abdominal events requiring surgical attention [11,12] because delayed intervention could be detrimental [17,18]. However, in our case series, only 2 episodes had GI lesions identified.…”

Section: Discussionmentioning

confidence: 66%

Peritoneal dialysis peritonitis by anaerobic pathogens: a retrospective case series

Chao,

Lee,

Yang

et al. 2013

BMC Nephrol

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BackgroundBacterial infections account for most peritoneal dialysis (PD)-associated peritonitis episodes. However, anaerobic PD peritonitis is extremely rare and intuitively associated with intra-abdominal lesions. In this study, we examined the clinical characteristics of PD patients who developed anaerobic peritonitis.MethodsWe retrospectively identified all anaerobic PD peritonitis episodes from a prospectively collected PD registry at a single center between 1990 and 2010. Only patients receiving more than 3 months of PD were enrolled. We analyzed clinical features as well as outcomes of anaerobic PD peritonitis patients.ResultsAmong 6 patients, 10 episodes of PD-associated peritonitis were caused by anaerobic pathogens (1.59% of all peritonitis episodes during study the period), in which the cultures from 5 episodes had mixed growth. Bacteroides fragilis was the most common species identified (4 isolates). Only 3 episodes were associated with gastrointestinal lesions, and 4 episodes were related to a break in sterility during exchange procedures. All anaerobic pathogens were susceptible to clindamycin and metronidazole, but penicillin resistance was noted in 4 isolates. Ampicillin/sulbactam resistance was found in 2 isolates. In 5 episodes, a primary response was achieved using the first-generation cephalosporin and ceftazidime or aminoglycoside. In 3 episodes, the first-generation cephalosporin was replaced with aminoglycosides. Tenckhoff catheter removal was necessary in 2 episodes. Only one episode ended with mortality (due to a perforated bowel).ConclusionAnaerobic PD-associated peritonitis might be predominantly caused by contamination, rather than intra-abdominal events. Half of anaerobic PD-associated peritonitis episodes had polymicrobial growth. The overall outcome of anaerobic peritonitis is fair, with a high catheter survival rate.

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Section: Discussionmentioning

confidence: 66%

Peritoneal dialysis peritonitis by anaerobic pathogens: a retrospective case series

Chao,

Lee,

Yang

et al. 2013

BMC Nephrol

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“…Chang et al [ 4 ] reported surgical intervention due to unrelieved abdominal symptoms and a great amount of turbid ascites after PD catheter removal in 2 cases of Pseudomonas -related peritonitis, and both patients survived. Suzuki et al [ 5 ] presented a rare case of peritonitis secondary to colon perforation caused by ingestion of a piece of bamboo in a PD patient; the PD catheter was removed, followed by peritoneal lavage and continuous abdominal drainage, and the patient finally recovered.…”

Section: Discussionmentioning

confidence: 99%

“…Generally, if an episode of peritonitis is secondary to acute abdomen such as gastric or intestinal perforation, appropriate procedures should follow surgical principles, and the aim should be effective source control, which refers to drainage of infected foci, controlling ongoing peritoneal contamination and restoration of anatomic and physiological function [ 6 ]. The PD catheter needs to be removed concomitantly, as in the case shown by Suzuki et al [ 5 ]. While an episode of refractory PD-related peritonitis is a primary one, the situation can be more complicated.…”

Section: Discussionmentioning

confidence: 99%

Surgical Intervention after Catheter Removal in a Case of Refractory Peritoneal Dialysis-Related Peritonitis

Yan¹,

Bian

Zhang³

et al. 2015

Case Rep Nephrol Dial

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Peritonitis is the most common infection in peritoneal dialysis (PD) and has been noted to be not only a cause of mortality but also the leading cause of technique failure in patients maintained on PD. Appropriate management of peritonitis to improve patient outcome has been the focus of clinical practice. We report a case of refractory PD-related peritonitis with surgical intervention intending to control ongoing peritoneal infection despite aggressive antibiotics and timely catheter removal. Exploratory laparotomy was performed in this case, and an encapsulated abscess in the peritoneal and pelvic cavity was obliterated. Adhesiolysis was done simultaneously. Continuous postoperative peritoneal lavage and drainage were implemented. Symptoms dramatically improved after operation, and indwelling tubes were removed several days later. Finally, the patient recovered and switched to permanent hemodialysis without intra-abdominal complications. Our case suggested that appropriate and timely surgical intervention in refractory peritonitis is necessary for saving lives in certain subgroups of patients. Clearly, well-designed studies with large samples are warranted to explore this issue in more detail.

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“…Touch contamination during PD fluid exchange is the most common cause of PD-related peritonitis [2]. Additionally, while uncommon, intestinal perforation is a critical complication that is difficult to diagnose in PD patients [3]. It has been reported that the mortality rate of perforative peritonitis is quite high [4].…”

Section: Introductionmentioning

confidence: 99%

Intestinal perforation by a peritoneal dialysis catheter in which fungal peritonitis led to diagnosis: a rare case report

Shima¹,

Mizoguchi²,

Morine

et al. 2018

CEN Case Rep

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Intestinal perforation by a peritoneal catheter is an uncommon, but serious, complication that has a high mortality rate. Intestinal perforation in peritoneal dialysis (PD) patients is difficult to diagnose using symptoms and radiological findings, which may result in a delay in diagnosis. Moreover, intestinal perforation complicated with fungal peritonitis is reportedly a severe condition with a poor prognosis. Herein, we report the case of a 78-year-old man on PD, whose diagnosis of perforative peritonitis was difficult to diagnose preoperatively. He was transferred to our hospital complaining of relapsing PD-related peritonitis due to Klebsiella oxytoca infection 2 months after the insertion of the PD catheter. He had been treated with various antibiotics in the previous hospital. Over the course of treatment, he complained of diarrhea, which was diagnosed as acute enteritis. Upon admission to our hospital, he had no abnormal clinical signs except for a cloudy PD effluent. Blood examination showed a high C-reactive protein level (8.41 mg/dL), a white blood cell count in the PD fluid of 367 cell/µL (neutrophils 55.1%), and the presence of Candida parapsilosis. We initiated antifungal therapy and, during catheter removal, found evidence of intestine perforations by the PD catheter, which were successfully repaired. After catheter removal and intestine repair, he recovered and was discharged to continue undergoing hemodialysis. Based on our case, we recommend that intestine perforations should be considered as a cause of relapsing PD-related peritonitis with abdominal symptoms, particularly watery diarrhea. Furthermore, catheter removal and antifungal administration should be initiated earlier after the diagnosis of fungal peritonitis.

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A case of perforative peritonitis caused by a piece of bamboo in a patient on peritoneal dialysis

Cited by 7 publications

References 18 publications

Peritoneal dialysis peritonitis by anaerobic pathogens: a retrospective case series

Peritoneal dialysis peritonitis by anaerobic pathogens: a retrospective case series

Surgical Intervention after Catheter Removal in a Case of Refractory Peritoneal Dialysis-Related Peritonitis

Intestinal perforation by a peritoneal dialysis catheter in which fungal peritonitis led to diagnosis: a rare case report

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