Incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis patient

Abstract

Patients treated with peritoneal dialysis have increased intra-abdominal pressure and a high prevalence of abdominal wall complications. Hernias can lead to significant morbidity in patients on peritoneal dialysis. Hernias are clinically important because of the risk of incarceration, strangulation and subsequent bowel obstruction, rupture, and peritonitis. In this paper, a case of incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis (CAPD) patient is reported. The small bowel obstruction improved after herniorrhaphy, and the peritoneal dialysis was resumed 2 weeks after the herniorrhaphy. The patient had been undergoing CAPD without technical failure until the 2 months follow-up after the herniorrhaphy. This case shows that early detection of incarcerated umbilical hernia and herniorrhaphy can prevent resection of a strangulated small bowel so that it can remain on CAPD without post-operative technical failure. Umbilical hernias should be carefully observed and intestinal obstruction should be considered when a CAPD patient with an umbilical hernia has abdominal pain.

Immediate Dialysis After Simultaneous Laparoscopic Peritoneal Dialysis Catheter Placement and Laparoscopic Inguinal Hernia Repair

“…Pre-existent hernia in patients with end-stage renal disease (ESRD) may be repaired before or at the time of peritoneal dialysis catheter (PDC) placement. [1][2][3] The high prevalence of inguinal hernias has been reported in patients before or while undergoing PDC placement. 1,4 It is important to examine and repair a hernia before initiating peritoneal dialysis (PD).…”

“…5,6 Furthermore, the occurrence of inguinal hernias can cause serious complications after PD initiation. 2,[7][8][9] Regular daily PD in patients with ESRD with a weak abdominal wall increases intra-abdominal pressure, which may contribute to the formation of new hernia and may provide insight regarding occult hernia. 1,10 Indeed, the occurrence of inguinal hernia in PD may lead to complications such as hernia obstruction, strangulation, hydrocele bowel obstruction, and dialysate leakage.…”

“…1,10 Indeed, the occurrence of inguinal hernia in PD may lead to complications such as hernia obstruction, strangulation, hydrocele bowel obstruction, and dialysate leakage. 1,2,11 Hence, surgeons should examine patients for hernia and repair them before initiating PD. 3 The laparoscopic placement of PDC is well documented.…”

Clinical benefits of routine examination and synchronous repair of occult inguinal hernia during laparoscopic peritoneal dialysis catheter insertion: a single-center experience

“…However, the injection of the dialysate inevitably increases the intra-abdominal pressure which may contribute to hernia formation, particularly in patients with abdominal weakness or defects [3][4][5]. Hernias in patients on PD are clinically important because it may cause complications such as dialysate leakage, hernia incarceration, strangulation, bowel obstruction, and peritonitis [4][5][6][7][8]. Hernia formation may lead to technique failure and conversion from PD to hemodialysis [1,8,9].…”

“…Hernias in patients on PD are clinically important because it may cause complications such as dialysate leakage, hernia incarceration, strangulation, bowel obstruction, and peritonitis [4][5][6][7][8]. Hernia formation may lead to technique failure and conversion from PD to hemodialysis [1,8,9]. For these reasons, the guidelines recommend that surgeon should detect and repair preexisting hernias in patients who have chosen PD as their dialysis modality [10].…”