Peritoneal Dialysis Catheter Removal Post-Transplant — A Rare Case of Delayed Bowel Perforation

Abstract

Peritoneal dialysis (PD) is a well-established form of renal replacement therapy and the practice of leaving catheters post-transplantation widely accepted. We present a rare complication: a child presenting with anal protrusion of the PD catheter.The patient is an 11-year-old boy with a background of renal dysplasia and congenital cutis laxa. Twenty-three weeks after dialysis was commenced, the patient underwent a renal transplant. Thirteen weeks post-transplant, the patient felt an unusual sensation after defecation. The curled end of the catheter was seen protruding from the anus. He was admitted, and investigations showed stable graft function, with abdominal X ray showing no free air.Intraoperative findings showed a small perforation of the sigmoid colon sealed off by adherence of several small intestinal loops. This was repaired laparoscopically after removal of the distal part of the catheter rectum. No peritoneal contamination was seen. He was treated with 5 days of intravenous antibiotics and gradual introduction of enteral feeds. His graft function remained stable throughout.Timing of catheter removal varies, from the time of transplantation to over 3 months post-transplantation. Bowel perforation due to PD catheter insertion is rare and tends to occur at the time of insertion. Anal protrusion of a PD catheter in childhood is extremely rare and unrecorded in a pediatric patient with a connective tissue disorder. Our case highlights that serious complications can occur in the period between transplantation and elective PD catheter removal and that, in the immunocompromised patient, signs can be subtle.

A Rare Complication of Peritoneal Dialysis (PD) Catheter: Perforation of Sigmoid Colon by Migrating Tip of Peritoneal Dialysis Catheter

“…However, this is the first pediatric case reported with asymptomatic perforation of the sigmoid colon by the tip of a PD catheter in an immunocompetent patient. The other 2 cases had similar presentation, with asymptomatic perforation of colon by a dormant catheter and catheter tip protruding through the anus, but they were maintained on immuno-suppression after kidney transplant [ 8 , 9 ]. Immunosuppression, particularly steroids, can mask the signs and symptoms of peritonitis following visceral perforation [ 3 ].…”

Peritoneal dialysis catheter exit via rectum

“…This complication has been reported before. 6 –8 This case is a reminder of this rare complication of the PD catheter.…”

Non-infectious complications of peritoneal dialysis in children

“…Клиника перитонита в данном случае также отсутствовала. Лапароскопически был удален катетер и ушита перфорация сигмовидной кишки без хирургических послеоперационных осложнений [22].…”