Delayed Bowel Perforation in a Peritoneal Dialysis Patient: A Case Report and Literature Review

Wang, Rending; Chen, Zhimin; Wang, Jiaxin; Zhang, Xiaohui; Shou, Zhangfei; Chen, Jianghua

doi:10.3747/pdi.2012.00345

Cited by 23 publications

(37 citation statements)

References 21 publications

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“…A long duration of a PD catheter in the abdominal cavity without peritoneal fluid, which bathes the bowel loops acting as a barrier of adhesion of the catheter to the bowel wall, increases the risk of pressure-induced necrosis by the immobile catheter. Review of the other cases in the literature indicated that half were attributable to an unused PD catheter, typically 1.6–48 months after use had ceased [6]. PWAT is a simple method of fixing the catheter on the abdominal wall to prevent catheter malposition [7].…”

Section: Resultsmentioning

confidence: 99%

Bowel perforation by a peritoneal dialysis catheter: report of two cases

et al. 2017

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BackgroundComplications of peritoneal dialysis (PD) such as pain and catheter leakage are frequently reported. Delayed bowel perforation of a PD catheter is a rare adverse event but a serious complication associated with significant mortality. Bowel perforation of a PD catheter is difficult to differentiate from PD-related peritonitis and likely to result in a delay in diagnosis. Here, we report two cases of bowel perforation after PD catheter insertion by the stepwise initiation of PD using the Moncrief and Popovich technique (SMAP) and peritoneal wall anchor technique (PWAT).Case presentationThe first case was a 53-year-old woman with end-stage renal disease (ESRD) due to diabetic nephropathy and a history of entero-adhesiolysis. She underwent PD catheter insertion by the SMAP with PWAT. Four months after PD catheter insertion, the catheter was found to perforate sigmoid colon. The second case was a 57-year-old woman with ESRD due to large polycystic kidney disease. She underwent the same procedure. After exteriorization of the catheter, she developed peritonitis due to perforation of the catheter tip into the bowel. Both patients were safely removed the catheter with uneventful recovery.ConclusionWe reported two cases of a rare complication of PD catheter. The SMAP method, PWAT, enlarged kidneys and migration of the lower cuff may be risk factors of bowel perforation of a PD catheter.

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Section: Resultsmentioning

confidence: 99%

Bowel perforation by a peritoneal dialysis catheter: report of two cases

et al. 2017

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“…First, the presence of free air or ascites may not become significant clues to diagnose intraperitoneal inflammation or gastrointestinal perforation. Second, peritoneal irritation symptoms may be alleviated during washing with the PD solution [11]. In the present case, the patient had a number of complications and Computed tomography upon ICU admission showed presence of free air in the peritoneal cavity, ascites, and mild edema of the gall bladder; however, no stones were found in the gall bladder or CBD comorbidities and suffered from an unexpected disaster.…”

Section: Discussionmentioning

confidence: 85%

“…Since then, there have been some reports of bowel perforation in patients receiving PD, which occurred relatively late after catheter placement as an uncommon complication of PD [10]. Wang et al summarized 28 cases of bowel perforation in patients receiving PD from 1980 to 2014 [11]. In their review, the colon was the most frequent site of perforation (64% of cases; sigmoid colon in 46% of cases) followed by the small intestine (25%).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding primary disease of the kidney, chronic glomerulonephritis, nephrosclerosis, polycystic kidney disease, and diabetic nephropathy each accounted for 14%; thus, there seems to be no kidney disease more likely to cause bowel perforation in the literature. The use of immunosuppressants and the presence of diverticulitis are recognized as risk factors for bowel perforation in patients receiving PD [11][12][13]. There are several reasons why diagnosis of peritonitis is sometimes difficult or delayed in patients receiving PD.…”

Section: Discussionmentioning

confidence: 99%

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Refractory peritonitis by spontaneous perforation of the common bile duct in a patient receiving peritoneal dialysis

et al. 2017

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Background: Patients with end-stage renal disease are in an immune-compromised state, with infection being the most common cause of mortality among those undergoing dialysis. Case presentation: A 73-year-old woman who had received 6 months of peritoneal dialysis (PD) presented with peritoneal irritation symptoms during hospitalization for examination of PD effluent turbidity. Emergent laparotomy was performed for acute biliary peritonitis, but the cause was undetermined because of severe adhesion, and surgery ended with washing and palliative drainage. Postoperative endoscopic retrograde cholangiopancreatography revealed spontaneous perforation of the common bile duct (CBD), and she was transferred to the intensive care unit (ICU) for treatment of septic shock. Treatment included antibiotics, drainage, mechanical ventilation, and continuous hemodiafiltration, but infection spread into the retroperitoneal tissue and right thigh gradually. On ICU day 53, she died due to multiple organ failure. Conclusions: Acute peritonitis due to spontaneous perforation of the CBD is very rare, and to our knowledge, this is the first report of biliary peritonitis in a patient receiving PD. Physicians should pay special attention to refractory peritonitis, including biliary peritonitis, occurring in patients receiving PD because some cases can be fatal.

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“…Delayed intestinal perforation by peritoneal dialysis (PD) catheter is a rare but serious complication that increases the risk of mortality in PD patients . Here we report an atypical case of delayed intestinal perforation by the PD catheter in a PD patient.…”

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confidence: 93%