Secondary Peritonitis in Peritoneal Dialysis: A Case Report and Review of Literature

Abstract

A 41-year-old female with Down's syndrome on peritoneal dialysis (PD) presented with PD-related peritonitis which was not responding to guideline-directed antimicrobial therapy. Computed tomography scan revealed air in the peritoneal cavity initially suspected to be secondary to her PD. Multiple enteric bacteria were identified in the PD fluid which raised suspicion for perforation. A perforated diverticulum was eventually diagnosed with exploratory laparotomy. Spontaneous perforated viscus in patients undergoing PD is rare, but without prompt and aggressive intervention may be associated with significant morbidity and mortality. We discuss the case and review the literature highlighting the delay in the diagnoses of such cases and the role of imaging and exploratory laparotomy. Finally, recovery of multiple enteric pathogens in the workup of PD-associated peritonitis should raise the suspicion of possible viscus perforation.

Incidence and clinical features of patients with peritoneal dialysis peritonitis complicated by bacteremia

“…We reviewed every patient's hospital course and excluded patients with intra-abdominal infections other than PD peritonitis because secondary peritonitis has a higher mortality rate. [5]…”