A patient with perforative peritonitis undergoing peritoneal dialysis: A case report

Takagi Ayano, Hatta Tsuguru, Ueno Risa, Kado Hiroshi, Segawa Hiroyoshi, Shiotsu Yayoi, Sawada Katsunori, Akioka Seiichi

doi:10.4009/jsdt.44.1039

A 68-year-old man with end-stage renal disease, undergoing continuous ambulatory peritoneal dialysis (CAPD) from October 2006, complained of excreting dialysate from the anus on 10 July, 2009. Twelve days previously, his blood examination showed a high C-reactive protein value (31.24mg/dL), but there were no symptomatic features. On admission, effluents from the CAPD catheter were impure, being mixed with saburra, but he had no pain, and there was no guarding or rigidity of abdominal muscles. Based on these findings, we suspected perforative peritonitis, and emergent surgery was performed. During the operation, we noticed a cavity around the tip of the catheter, but it was difficult to identify the site of perforation because of intestinal adhesion. We speculate on the cause of perforation as follows. About 2 weeks previously, minor perforation occured due to a divertilum. Divertilulitis and adhesion developed with the PD catheter and, finally, the PD catheter perforated to the lumen of the sigmoid colon. In general, perforative peritonitis in a patient undergoing PD is often difficult to diagnose because free air and ascites are not specific. Continuous lavage reduces the acute symptoms. These factors lead to the high mortality. So, perforative peritonitis is an extremely important complication, but is sometimes difficult to diagnose because of peritoneal dialysis itself. Because of this, we should be aware of the muddiness of the dialysate and hypoproteinemia and inflammation signs to avoid this fatal complication.

A patient with perforative peritonitis undergoing peritoneal dialysis: A case report

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