Abdominal visceral perforation by buried peritoneal dialysis catheters: Cause or coincidence?

Abstract

Delayed visceral organ perforations after PD catheter insertions are extremely rare. We report two patients who presented with asymptomatic visceral perforation from their buried PD catheters. Five months after a laparoscopic buried PD catheter insertion in a 92-year-old man PD was initiated; bile and bowel contents were noted in the PD effluent. He subsequently expired (from pneumonia) to autopsy revealed the PD catheter within the small bowel. Despite this perforation, there was no evidence of peritonitis, inflammation, nor any bowel content within the peritoneal cavity. A second case was observed 2.5 months after an uncomplicated laparoscopic buried PD catheter insertion in a 60-year-old woman. PD was attempted; the patient had an immediate urge to void. MRI revealed the presence of the PD catheter within her bladder. She underwent PD catheter revision the next day with repair of bladder perforation and ultimately successfully initiated PD. Since the perforations did not occur at the time of catheter placement, we believe that the catheter eroded into a viscus, perhaps related to the lack of a fluid at the catheter - viscus interface. The diagnosis of delayed visceral organ perforation following buried PD catheter insertion may be delayed because the catheter is not immediately used.

Intestinal Perforation Secondary to Peritoneal Dialysis Catheter; An Uncommon Complication

“…There is a report of cases of patients who remain asymptomatic, which may be due to the closure of the intestinal perforation due to the infl ammatory process, the formation of adhesions and fi brosis; This is consistent with the intraoperative fi ndings and the absence of clinical or radiological data of intestinal perforation in our patient [4,5]. In some cases, when the clinical presentation suggests a picture of peritonitis, it is diffi cult to determine whether it is secondary to peritoneal dialysis or a problem secondary to intestinal perforation, in these cases of doubt, imaging studies such as computed tomography and catheterization can help to establish the diagnosis, and its performance is suggested if after 3 days of conservative treatment there is no resolution of the symptoms [6][7][8]. Once the diagnosis is made, early surgical management with catheter removal and primary closure of the perforation generally offers a good prognosis for patients.…”

Successful Initiation of Dialysis with a 20-Year-Old Buried Peritoneal Dialysis Catheter: Case Report and Literature Review

“…Other benefits include flexibility in PD initiation, reduced need for bridging hemodialysis in urgent starts, low rates of infectious complications, and cuff extrusion. While there are occasional reports of visceral perforation with a dormant PD catheter [12], similar reports of trauma have occurred with other methods of catheter insertion [13].…”

Acute Peritoneal Dialysis With Percutaneous Catheter Insertion for COVID-19–Associated Acute Kidney Injury in Intensive Care: Experience From a UK Tertiary Center

“…In our study, no complications leading to significant harm were reported following catheter insertion even in those with failed catheter insertion attempts. Bowel and bladder injury are described in both blind and direct insertion, 15 but did not occur other than a potential needle insertion into bowel without adverse consequences.…”