Modified computed tomography peritoneography: Clinical utility in continuous ambulatory peritoneal dialysis patients

Abstract

The purpose of the present paper is to review the indications, results, clinical correlation and implications for management of a modified CT peritoneography (CTP) technique in the evaluation of continuous ambulatory peritoneal dialysis (CAPD) patients. Forty CTP in 33 patients were reviewed by two observers blinded to clinical history or outcome. The CTP technique included 100 mL non-ionic intraperitoneal contrast, 1 h of ambulation and prone positioning during the CT. No precontrast or delayed examinations were performed. A CAPD-related complication was diagnosed in 33 of 40 (82%) CTP. Twenty-nine CTP were performed for evaluation of suspected dialysate leaks. In this group there were 18 leaks, a total of seven umbilical hernias (five as isolated findings) and five normal studies. Nine of 18 (50%) leaks resolved with conservative management and six of nine patients (67%) of the remainder continued CAPD after appropriate surgery. Seven patients were evaluated for scrotal swelling (one bilateral), and there were five communicating hydroceles (all with inguinal fat herniation and all surgically confirmed) and three non-communicating hydroceles (none of which progressed). Umbilical hernias were present in nine of 33 patients (27%). No false positive or false negative studies were identified. The CTP technique described provides accurate diagnostic information in the management of common CAPD-related complications, particularly dialysate leak, genital swelling, abdominal wall hernias and peritoneal adhesions. Computed tomography peritoneography directs appropriate conservative or surgical management.

Serial changes of computed tomographic peritoneogram in patients with symptomatic ultrafiltration failure complicating continuous ambulatory peritoneal dialysis

“…Various incidence rates for dialysate leakage have been reported in the literature. Most sources indicate that dialysate leakage occurs in more than 5% of patients undergoing CAPD . Dialysate may leak through the peritoneal catheter exit site, abdominal wall hernia or a patent processus vaginalis in patients with CAPD .…”

“…Continuous ambulatory peritoneal dialysis is used to treat end staged renal failure (ESRF) in increasing number of patients . Tenckhoff and Schechter described the use of a permanent indwelling silicone rubber catheter for peritoneal dialysis in 1968 . CAPD has an advantage over haemodialysis in that it allows patients greater freedom to perform daily activities among other clinical benefits.…”

“…Complications with an infective cause include bacterial peritonitis, tuberculous peritonitis, and infections of the catheter exit site and tunnel. Non‐infective complications include catheter dysfunction, dialysate leakage, hernias and sclerosing encapsulating peritonitis …”

Transdiaphragmatic peritoneal hernia complicating peritoneal dialysis: demonstration with spiral computed tomography peritoneography and peritoneal scintigraphy

“…Thoracocentesis was not performed here because of the car-crash context. CT identified a peritoneal hernia into the posterior mediastinal space that was immediately opacified by the intraperitoneal contrast media injection [1][2][3]. By contrast, the communication between the right pleural space and the peritoneal cavity was demonstrated neither by early nuclear medicine imaging (an observation Kanaan et al [4] also made in two previous cases), nor by the CT examination.…”

Hydrocele in a Peritoneal Dialysis Patient: Hernia or Leakage

“…Computed tomography peritoneography is accurate for diagnosing peritoneal defects, by using dialysis fluid mixed with contrast. It facilitates the diagnosis and surgical planning by demonstrating the site, size and anatomy (2). Due to the high recurrence rate, even small hernias should be repaired and early detection can prevent more serious complications like small bowel strangulation or intestinal incarceration.…”