Perforation of the small intestine incarcerated within the deformed pelvic cavity by hip arthroplasty in a CAPD patient

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  • Tokuyama Hirobumi
    Department of Internal Medicine, School of Medicine, Keio University
  • Washida Naoki
    Department of Internal Medicine, School of Medicine, Keio University
  • Wakino Shu
    Department of Internal Medicine, School of Medicine, Keio University
  • Hara Yoshikazu
    Department of Internal Medicine, School of Medicine, Keio University
  • Fujimura Keiko
    Department of Internal Medicine, School of Medicine, Keio University
  • Itoh Arata
    Department of Internal Medicine, School of Medicine, Keio University
  • Ueyama Nao
    Department of Internal Medicine, School of Medicine, Keio University
  • Nomura Motoko
    Department of Internal Medicine, School of Medicine, Keio University
  • Hayashi Koichi
    Department of Internal Medicine, School of Medicine, Keio University
  • Itoh Hiroshi
    Department of Internal Medicine, School of Medicine, Keio University

Bibliographic Information

Other Title
  • 急性腹膜炎として治療し，後に小腸嵌頓による腸管穿孔が判明したＣＡＰＤ患者の１例
  • 症例報告 急性腹膜炎として治療し,後に小腸嵌頓による腸管穿孔が判明したCAPD患者の1例
  • ショウレイ ホウコク キュウセイ フクマクエン ト シテ チリョウ シ ノチ ニ ショウチョウカントン ニ ヨル チョウカン センコウ ガ ハンメイ シタ CAPD カンジャ ノ 1レイ

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We report a 46-year-old female patient on continuous ambulatory peritoneal dialysis(CAPD) who experienced perforation of the ileum incarcerated within the deformed pelvic cavity behind the metal bolt of the implanted head of the right femur. The patient had undergone right hemi-pelvectomy accompanied by total hip arthroplasty for alveolar soft-tissue sarcoma at the age of 41. She was also being treated by CAPD as therapy for end-stage renal disease resulting from hypertensive nephrosclerosis since 2007. In March 2008, she underwent surgery for femur neck fracture and the metal bolt was implanted. She developed abdominal pain in May 2008, which became aggravated and showed turbid CAPD fluid. She was admitted to our hospital because of peritonitis. Six-day administration of antibiotics resulted in no improvement, and her symptoms became further aggravated demonstrating and an increased cell count in cloudy brown-yellow CAPD fluid. Three species of bacilli were detected in the CAPD fluid and imipenem/cilastatin sodium(IPM/CS) was administered. As there was no improvement, we performed abdominal computed tomography and detected a free air space within the abdominal cavity. Emergency surgery demonstrated that the head of the metal bolt was palpable in the pelvic cavity and the small intestine was incarcerated behind it within the deformed pelvic cavity due to partial pelvectomy. Furthermore, there was a perforation at the terminal ileum. Partial ileectomy was performed and the postoperative course was uneventful. Her dialysis therapy was switched to hemodialysis. Perforation of the small intestine incarcerated within the deformed pelvic cavity following hip arthroplasty in a CAPD patient has not been reported previously. A procedure that deforms pelvic cavity may precipitate incarceration leading to complicated peritonitis, which should be differentiated from simple peritonitis.

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