Delayed Decubitus Perforation of the Bowel Is a Sword of Damocles in Patients on Peritoneal Dialysis

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

“…Additionally, Rubin et al reported that bowel perforation occurred in 0.1% with conventional catheter implantation techniques, that is, neither SMAP nor PWAT was used [4]. Kagan, et al and Chu, et al speculated that dormant catheters are more likely to erode the bowel [2, 5]. 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.…”

“…Erosion of the PD catheter into the bowel is a rare complication, and patients experience serious consequences such as peritonitis, difficulty in draining, and feculent dialysate effluent with watery diarrhea [1]. Kagan, et al reviewed the publications from 1980 to 1995 and delayed bowel perforation is associated with a 29% mortality [2]. Perforative peritonitis in a patient undergoing PD is often difficult to diagnose because free air and ascites are not specific.…”

A rare but serious complication of continuous ambulatory peritoneal dialysis: delayed perforation of the colon by the Tenckhoff catheter

“…The continuous pressure causes local ischaemia, eventually leading to erosion, laceration, and frank perforation. 1 Lack of fluid in the peritoneal space after cessation of CAPD predisposes to pressureinduced necrosis because of loss of the fluid cushion. 2,3 In our patient, perforation was unlikely when the catheter was in daily use because it did not come into continuous close contact with the bowel for any long period of time.…”

“…4 In most previous studies, delayed perforation of the bowel was associated with acute peritonitis. 1,3,5,6 Kagan and Bar-Khayim 1 reviewed the publications from 1980 to 1995 and identified 24 cases of bowel perforation during the study period. All cases were associated with acute peritonitis, with 29% mortality and significant morbidity.…”

Reply

“…Cincinnati. Ohio, USA Dear Sir, Kagan et al [1] recently emphasized that delayed perforation of the bowel during long-term peritoneal dialysis (PD) is a rare but well-documented entity which is associ ated with significant morbidity and mortali ty. They described the pathophysiology of the erosion and attributed it to chronic local ized ischemia of the bowel wall resulting from the intimate contact of the PD catheter tip with the bowel wall.…”