Bowel perforation by a peritoneal dialysis catheter: report of two cases

Abstract

BackgroundComplications of peritoneal dialysis (PD) such as pain and catheter leakage are frequently reported. Delayed bowel perforation of a PD catheter is a rare adverse event but a serious complication associated with significant mortality. Bowel perforation of a PD catheter is difficult to differentiate from PD-related peritonitis and likely to result in a delay in diagnosis. Here, we report two cases of bowel perforation after PD catheter insertion by the stepwise initiation of PD using the Moncrief and Popovich technique (SMAP) and peritoneal wall anchor technique (PWAT).Case presentationThe first case was a 53-year-old woman with end-stage renal disease (ESRD) due to diabetic nephropathy and a history of entero-adhesiolysis. She underwent PD catheter insertion by the SMAP with PWAT. Four months after PD catheter insertion, the catheter was found to perforate sigmoid colon. The second case was a 57-year-old woman with ESRD due to large polycystic kidney disease. She underwent the same procedure. After exteriorization of the catheter, she developed peritonitis due to perforation of the catheter tip into the bowel. Both patients were safely removed the catheter with uneventful recovery.ConclusionWe reported two cases of a rare complication of PD catheter. The SMAP method, PWAT, enlarged kidneys and migration of the lower cuff may be risk factors of bowel perforation of a PD catheter.

Delayed peritoneal dialysis catheter‐intestinal fistula

“…This is a rare case of delayed intestinal perforation by PD catheter. Although many cases of intestinal perforation by the tip of the PD catheter have been reported, a fistula between a side hole of the PD catheter and intestine has not been reported . A long implantation duration (9 months) of the PD catheter in the peritoneal cavity without PD solution may have contributed to the development of this complication in the present case, similar to previously reported cases .…”

Surgical complications after Tenckoff catheter implant

“…Symptoms of perforation of the small intestine or bladder after blind catheter insertion may remain silent for some time after surgery and may be associated with good initial catheter function, making the diagnosis more elusive. Surgical repair of the perforation site and intravenous antibiotic therapy are mandatory (6).…”

Splenic abscess diagnosed following relapsing sterile peritonitis in a peritoneal dialysis patient: A case report with literature review

“…We reviewed the relevant literature on PubMed for secondary peritonitis in PD patients since 2017 (Table 1). [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Out of the 16 cases, perforation was the most common cause of secondary peritonitis, which might be easier to diagnose due to changes in dialysate properties. Two cases were complicated with abscesses in the kidney 8 and the spleen, as shown in our case, respectively.…”