Pancreatitis Is a Silent Killer in Peritoneal Dialysis With Difficult Diagnostic Approach

Abstract

Until 2018, 236 cases of acute pancreatitis have been reported in patients who underwent peritoneal dialysis. Here, we presented a patient with double renal transplantation with chronic renal failure, under renal replacement therapy by peritoneal dialysis, who developed acute pancreatitis with abdominal pain, nausea, vomiting, leukocytosis with neutrophil left shift which is complicated by pancreatic pseudocyst, candida peritonitis, fungal sepsis, overlapping of Acinetobacter baumannii sepsis, and pneumonitis. After the percutaneous cystogastrostomy drainage of pancreatic pseudocyst, changes from peritoneal dialysis to hemodialysis, various thoracentesis, and polyantibiotics therapy, the resolution of the sepsis state was seen. The particular aspect of our case is the various comorbidity risks, severe pancreatitis associated with candida and A baumannii sepsis, and treatment strategy that lead to heal this kind of the high mortality rate condition.

A unique pancreatic phenotype in a child with a WDR19‐related ciliopathy: A case report and literature review of pancreatic involvement in ciliopathies

“…The patient's first episode of pancreatitis occurred while she was receiving PD. There are controversial data regarding the risk of pancreatitis while on PD, but there have been case reports and small observational studies that show a relative increased risk of pancreatitis on PD and HD compared with non‐dialysis patients (Aliotta et al, 2018; Lee, Ahn, et al, 2015; Lee, Hung, et al, 2015; Pohl & Uc, 2015; Vidal et al, 2019). Pancreatitis related to long‐term dialysis shows histological findings of duct ectasia, flattening of acinar cells with loss of zymogen granules, and inspissated secretions, which were not seen in our patient.…”

Forgotten intrauterine device inducing aseptic peritonitis in newly started peritoneal dialysis

“…Peritoneal leukocytosis with cloudy peritoneal effluent could happen in medical conditions rather than infection as in intra-abdominal malignancy [7], especially lymphoma, which could cause atypical cells with or without PMNs dominant cell count. Pancreatitis [8] or exposure to local or systemic amphotericin would also increase PMNs [9]. Peritoneal dialysis catheter placement laparoscopic techniques using CO2 inflation may elicit an allergic reaction with subsequent peritoneal eosinophilia [9].…”

The management of acute pancreatitis among children on chronic ambulatory peritoneal dialysis during COVID-19 pandemic crisis in Indonesia: report of two cases

“…5 Some established factors suggest that PD patients are more prone to AP, including toxic substances in PD components, local hypercalcemia in the pancreas due to calcium in PD solution, PD-related peritonitis, and high intraabdominal pressure caused by peritoneal fluid. [4][5][6] The concentration of glucose used in the dialysate may cause hyperglycemia and hypertriglyceridemia, which are associated with pancreatitis. 4, 5 Children on dialysis are also frequently exposed to medications, including Valproic acid and ACE inhibitors known to be associated with AP.…”

“…5 Acute pancreatitis in CAPD patients may be coexistence with peritonitis, which is clinically challenging to differentiate. 5,6 Here, we report two cases of AP in children with CAPD following PD-related peritonitis episodes.…”