Computerized Tomographic Scanning with Intraperitoneal Contrast Enhancement in a CAPD Patient with Localized EDEMA

Abstract

In a patient on continuous ambulatory peritoneal dialysis with localized abdominal and genital edema, the site of extraperitoneal dialysate leakage was determined by computerized tomographic scanning with intraperitoneal contrast enhancement. No adverse effects were encountered. The source of fluid leakage should be sought in CAPD patients with localized (i.e. genital) edema, because often they may have an undetected hernia or other peritoneal defect. Removal of the peritoneal dialysis catheter would not solve such a problem. In such cases, intraperitoneal contrast-enhanced CT scanning may represent an effective technique for identifying the site of dialysate leakage. Abdominal and inguinal hernias are well-recognized complications of con tinuous ambulatory peritoneal dialysis (CAPD). Dialysate may escape from the peritoneal space through such hernias; also the development of genital edema in a CAPD patient may indicate the presence of an inguinal hernia, which otherwise may be impossible to detect clinically (I). In CAPD patients who have had multiple abdominal operations, there may be numerous possible sites of hemia development and dialysate leakage, so that it may prove difficult to identify and repair the defect. We describe a patient in whom contrast-enhanced computerized tomographic scanning was used to identify the site of extraperitoneal dialysate leakage.

Dialysate Leaks in Peritoneal Dialysis

“…If the diagnosis is uncertain or if there is a clinical need to demonstrate the anatomy of the leak, an imaging approach becomes desirable. Available methods include intraperitoneal infusion of contrast material through the catheter with plain abdominal radiography, computed tomography (CT) (19, 20), or intraperitoneal infusion of a radioisotope (technetium‐tagged macroaggregated albumin) followed by peritoneal scintigraphy (21). The most widely used approach to determine the exact site of the leakage is with CT after infusion of 2 L of dialysis fluid containing radiocontrast material.…”

Evaluation and Management of Ultrafiltration Problems in Peritoneal Dialysis

“…Localized abdominal wall edema or subcutaneous fluid collections are often evident. Diagnosis is confirmed by utilizing radiographic techniques that include intraperitoneal infusion of a dialysis solution in which radiographic contrast has been added (with computed tomography) (Table 4), or through the intraperitoneal infusion of radioisotope with peritoneal scintigraphy (23)(24)(25)(26)(28)(29)(30)(31).…”

Compatibility and stability of non-ionic iodinated contrast media in peritoneal dialysis solution and safe practice considerations for CT peritoneography

“…Computerised tomographic (CT) peritoneography has been used to identify leaks from peritoneal boundary defects, dialysate maldistributions and loculated unopacified fluid collections in peritoneal dialysis (PD) patients. [1][2][3][4] The diagnostic study consists of infusing iodinated contrast media mixed with PD solution through the PD catheter into the peritoneal cavity followed by CT imaging. No immediate adverse drug reactions were reported when either ionic or non-ionic iodinated contrast media were used for the study.…”

“…No immediate adverse drug reactions were reported when either ionic or non-ionic iodinated contrast media were used for the study. [1][2][3][4][5][6] No change in residual kidney function was observed in 25 patients 1 week following CT peritoneography using non-ionic contrast. 7 Uremic animal studies utilising a range of non-ionic contrast media-dialysis solution concentrations for CT peritoneography with prolonged post-imaging solution exposure had small effects on the peritoneal membrane and residual kidney function.…”