Refractory peritonitis by spontaneous perforation of the common bile duct in a patient receiving peritoneal dialysis

Abstract

Background: Patients with end-stage renal disease are in an immune-compromised state, with infection being the most common cause of mortality among those undergoing dialysis. Case presentation: A 73-year-old woman who had received 6 months of peritoneal dialysis (PD) presented with peritoneal irritation symptoms during hospitalization for examination of PD effluent turbidity. Emergent laparotomy was performed for acute biliary peritonitis, but the cause was undetermined because of severe adhesion, and surgery ended with washing and palliative drainage. Postoperative endoscopic retrograde cholangiopancreatography revealed spontaneous perforation of the common bile duct (CBD), and she was transferred to the intensive care unit (ICU) for treatment of septic shock. Treatment included antibiotics, drainage, mechanical ventilation, and continuous hemodiafiltration, but infection spread into the retroperitoneal tissue and right thigh gradually. On ICU day 53, she died due to multiple organ failure. Conclusions: Acute peritonitis due to spontaneous perforation of the CBD is very rare, and to our knowledge, this is the first report of biliary peritonitis in a patient receiving PD. Physicians should pay special attention to refractory peritonitis, including biliary peritonitis, occurring in patients receiving PD because some cases can be fatal.

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“…The fluid inside is affected too and modifies the turbidity, so it can be measured to detect this anomaly and take actions to prevent the advance [ 24 ]. It can be detected if there are filtrations by an abscess or something else that was not present at that time or if a perforation in some part of the intestines was made when the peritoneal dialysis was practiced [ 25 , 26 , 27 ]. If the peritonitis is not detected on time, it can cause severe complications such as bacterial or fungal peritonitis [ 28 ].…”