Acute Sterile Peritonitis

Abstract

We have encountered a sporadic form of aseptic peritonitis, not previously described, that we refer to as acute sterile peritonitis (ASP). This syndrome, which occurs with a frequency of 0.1% of dialyses, begins abruptly during peritoneal dialysis with abdominal pain, fever, and occasionally chills and vomiting. Coincident with the onset of symptoms, the dialysate return becomes cloudy with many white blood cells. Cultures are negative and resolution occurs within hours with continued dialysis. In this report we detail the clinical features of this new syndrome.

Sterile Peritonitis in the Peritoneal Dialysis Patient

“…The mechanism presumably is transmural inflammation of the viscus, resulting in the overlying visceral peritoneum becoming inflamed. Rupture of a sterile intraperitoneal abscess as a result of previous intra-abdominal infection was reported by Alpert et al as a further cause of sterile peritonitis (17).…”

Noninfectious Causes of Cloudy Peritoneal Dialysate

“…In most instances, continued dialysis afforded resolution of the pain within hours despite no antibiotic administration (four of six patients). Labeled “acute sterile peritonitis,” this syndrome was felt to be most consistent with the sudden rupture of a sterile intraperitoneal abscess that may have formed as a consequence of previous intra‐abdominal infection (5).…”

When the color of peritoneal dialysis effluent can be used as a diagnostic tool

“…As reported by Rocklin and Teitelbaum, excessive PMN in PD fluid have also been described in abdominal problems inducing reactive inflammation, such as splenic infarction, ischemic colitis, renal cell cancer, pancreatitis, cholecystitis, appendicitis, hernia, small bowel incarceration, and juxta peritoneal abscess . Abrupt diffuse abdominal pain, excessive PMN in dialysate effluent, and quick favorable evolution without antibiotic treatment are suggestive of an intraperitoneal sterile abscess rupture, usually a remnant of an old peritonitis …”

“…31 Abrupt diffuse abdominal pain, excessive PMN in dialysate effluent, and quick favorable evolution without antibiotic treatment are suggestive of an intraperitoneal sterile abscess rupture, usually a remnant of an old peritonitis. 32 In 1977, two Canadian hospitals experienced an epidemic of 48 episodes of aseptic neutrophilic peritonitis which was found to be secondary to endotoxin contamination of the peritoneal dialysis fluid. 33 A similar story happened again 20 years later in Pennsylvania.…”