Acute pancreatitis in peritoneal dialysis

Abstract

Abdominal pain with a discoloured dialysate in a patient on peritoneal dialysis (PD) is usually attributed to infective peritonitis. Although acute pancreatitis (AP) is not usually a complication of end-stage renal disease, some studies suggest an increased risk especially in patients on PD. We report a case of idiopathic AP in a 41-year-old female on PD who presented with abdominal pain, fever, vomiting and a clear dark dialysate. Initial diagnosis of PD-associated infective peritonitis was made but dialysate cultures proved negative. Serum amylase showed a mild rise and computed tomography revealed necrotising pancreatitis. No common risk factors for AP were identified and she was successfully treated with conservative therapy. A literature review was carried out using a PubMed search with the words 'acute pancreatitis and peritoneal dialysis'. The literature search found a total of 94 cases of AP in the setting of PD. In more than a quarter, no cause for AP was found. Serum amylase was normal in 12.8% of episodes. Complications developed in 25 cases, and 28 patients died from the condition. Therefore, AP can be a rare, but serious complication of PD with a high mortality and must be considered in the differential diagnosis of abdominal pain in a PD patient.

Peritoneal Dialysis Complicated by Severe Acute Pancreatitis: A Case Report

“…Therefore, solely relying on laboratory tests for diagnosing AP in PD patients can be challenging, and additional imaging examinations may be required. [8] Reports have shown that serum amylase levels in PD patients can be three times higher than the upper limit of normal. When the peritoneal fluid amylase level is > 100 U/L, making the early diagnosis of AP may be possible.…”

Complications of Peritoneal Dialysis Part II

“…Examples include pancreatitis as well as splenic abscess and infarction. 38,39 Solid organ malignancies including renal cell carcinoma and endometrial cancer have been reported to present initially with a neutrophil predominant dialysate. [40][41][42] In these cases, imaging is recommended if clinical assessment including the physical examination suggests an intraabdominal pathology.…”

Peritoneal dialysis-associated peritonitis, caused by superior mesenteric artery thrombosis with intestinal necrosis: a case report

“…Enteric peritonitis, one of the established categories of PD-associated peritonitis, is defined as peritonitis arising from an intestinal or intra-abdominal organ source, and recognized as one of the conditions that should be considered in the case of culture-negative peritonitis [8]. PD-associated peritonitis owing to some severe diseases, such as pancreatitis, appendicitis, and thrombosis, is included in this category [2,[9][10][11]. Furthermore, a delay in the diagnosis or treatment of enteric peritonitis has been reported to increase the associated mortality rate by approximately 50% [12,13].…”