Fig 1 - available from: BMC Nephrology
This content is subject to copyright. Terms and conditions apply.
a Contrast catheterography showed accumulation of the contrast agents in the sigmoid colon. b The bowel perforation of PD catheter (arrowhead) was seen on computed tomography scan. c Computed tomography scan with contrast agents into the catheter (arrow) showed accumulation of the contrast agents in the colon and rectum
Source publication
Background
Complications 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 t...
Similar publications
Abstract Background Bowel perforation in peritoneal dialysis (PD) is mainly caused during the perioperative period. Delayed bowel perforation is difficult to diagnose because of its heterogenous clinical signs and rarity. Previously, the methods to diagnose delayed bowel perforation were invasive, but computed tomography (CT) peritoneography is now...
Citations
... Peritoneal dialysis (PD) is widely utilized in patients with renal failure due to its high level of safety and efficacy. Pain and catheter leakage are the most commonly reported issues associated with PD (1). However, the occurrence of catheter penetration through the intestinal wall, leading to intestinal perforation, is a rare complication that can have severe consequences, including peritonitis, impaired drainage, and severe diarrhea (2). ...
Background
Peritoneal dialysis (PD) is a common treatment method for patients with renal failure. While peritonitis and tube floating migration are commonly observed complications, visceral perforation caused by PD is relatively rare. We present a case report of a patient undergoing PD due to renal failure, who encountered two instances of visceral perforation. In both occurrences, Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) played a pivotal role in providing accurate diagnoses and precise localization of the perforation sites. This report underscores the paramount significance of SPECT/CT in diagnosing visceral perforations in the context of PD.
Case presentation
A 73-year-old elderly male has been undergoing PD for 1 year due to renal failure. Recently, there has been impaired drainage of the PD catheter. The clinical team suspected the occurrence of peritonitis. The patient underwent a 99mTc Sodium Pertechnetate (99mTc-NaTcO4) SPECT/CT examination, which identified intestinal perforation. After 20 days of conservative treatment, a SPECT/CT follow-up examination revealed the resolution of the intestinal perforation, but a new bladder perforation emerged. The dialysis catheter was methodically and gradually withdrawn in stages while simultaneously performing bladder decompression. Following these interventions, the patient remained free from peritonitis and cystitis.
Conclusion
The utilization of SPECT/CT proved to be highly valuable in the accurate diagnosis of visceral perforation, a relatively rare complication observed in PD patients.
... 4,11 The cause of delayed intestinal perforation related to PD catheters is still unclear. The previously reported risk factors for PD catheter to intestinal perforation include the use of immunosuppressants, the presence of diverticulitis, 12 colon amyloidosis, 5 the prolonged suspension of PD catheter without removal, 3 the operation mode of PD catheter placement, 13,14 and the associated factors that increase abdominal pressure, such as polycystic kidney. 4 Our patient did not have these risk factors mentioned in previous studies. ...
Key Clinical Message
Delayed intestinal perforation has various manifestations. For peritonitis with delayed treatment and multi‐bacterial peritonitis, we should be alert to the occurrence of this rare complication. Abdominal CT examination and imaging results judgment based on clinical conditions are particularly important for diagnosis. Delayed intestinal perforation of peritoneal dialysis catheter is a rare but serious complication. We reported a 49‐year‐old patient who had been hospitalized twice within 3 months due to poor drainage of the peritoneal dialysis catheter. During the first hospitalization, peritoneal dialysis‐related peritonitis was diagnosed, and a variety of bacterial infections were cultivated. However, at that time, the actual peritoneal dialysis catheter‐related intestinal perforation was missed, and he was discharged after anti‐infection treatment until a clinical cure was met. After more than 2 months of normal peritoneal dialysis after returning home, the patient again had poor drainage of the peritoneal dialysis catheter, accompanied by the outflow of yellowish‐brown sediment. It was found that the peritoneal dialysis catheter had evidence of intestinal perforation. After the removal of the catheter and intestinal repair, he recovered and was discharged from the hospital and received long‐term hemodialysis treatment. In the case of delayed intestinal perforation, peritoneal dialysis was maintained normally for more than 2 months, which was an unprecedented situation in previous case reports. In addition, we should be alert to the occurrence of this rare complication, especially when we find the occurrence of polybacterial Peritonitis. Abdominal CT examination and imaging results judgment based on clinical conditions are particularly important for diagnosis.
... Catheter embedding is one of the procedures for planned PD initiation [9,10], sometimes called SMAP: Stepwise initiation of PD using Moncrief and Popovich's technique [10][11][12][13]. Catheter embedding comprises two steps: embedded catheter implantation and catheter externalization with exit-site catheter fixation. ...
... For elderly patients, obtaining some medical techniques and learning knowledge of their disease is harder than young to middleaged patients [23]. A Spanish cohort study including 135 patients mainly with planned PD initiation at a university hospital reported that the median training sessions for PD were 10 (interquartile range [8][9][10][11][12][13] and the training duration was 19 days (interquartile range 14-28) [24]. In their study, 31 patients (23%) needed prolonged training sessions, defined as more than 13 training sessions. ...
Background
Compared with the conventional peritoneal dialysis (PD) catheter insertion, embedding PD catheter implantation is one of the procedures for planned PD initiation. However, facilities where embedded PD catheter implantation is available are limited, and the impact of embedded PD catheter implantation on hospitalization cost and length of hospitalization is unknown.
Methods
This retrospective single-center cohort study included 132 patients with PD initiation between 2005 and 2020. The patients were divided into two groups: 64 patients in the embedding group and 68 patients in the conventional insertion group. We created a multivariable generalized linear model (GLM) with the gamma family and log-link function to evaluate the association among catheter embedding, the duration and medical costs of hospitalization for PD initiation. We also evaluated the effect modification between age and catheter embedding.
Results
Catheter embedding ( β coefficient − 0.13 [95% confidence interval − 0.21, − 0.05]) and age (per 10 years 0.08 [0.03, 0.14]) were significantly associated with hospitalization costs. Catheter embedding (− 0.21 [− 0.32, − 0.10]) and age (0.11 [0.03, 0.19]) were also identified as factors significantly associated with length of hospitalization. The difference between the embedding group and the conventional insertion group in hospitalization costs for PD initiation ( P for interaction = 0.060) and the length of hospitalization ( P for interaction = 0.027) was larger in young-to-middle-aged patients than in elderly patients.
Conclusions
Catheter embedding was associated with lower hospitalization cost and shorter length of hospitalization for PD initiation than conventional PD catheter insertion, especially in young-to-middle-aged patients.
... 1,3 Recently, many modifications have been proposed in order to reduce complications related to peritoneal dialysis and to PD catheter placement as: downward and lateral exits sites, and various dressings and treatments to reduce catheter site infection and/or peritonitis. [3][4][5][6] Furthermore, omentectomy have been advocated to reduce the rate of catheter obstruction. Recently, an experience with laparoscopic PD catheter placement has been evaluated to determine the impact on complications. 4 At our institution, open PD catheter placement and laparoscopic-assisted PD catheter placement have been used based upon individual surgeon preference, or patient's conditions. ...
... Decubitus bowel perforations have to be differentiated from HUS bowel perforations Delayed bowel perforations in patients on chronic dialysis without associated intestinal conditions have been described as isolated case reports. 6 A long duration of a PD catheter in the abdominal cavity without peritoneal fluid, which bathes the bowel loops acting as a barrier of adhesion of the catheter to the bowel Article wall, increases the risk of pressure-induced necrosis by the immobile catheter. The mechanism of perforation has also been debated in these above-mentioned case reports. ...
Peritoneal Dialysis (PD) is one of the numerous options for chronic dialysis and in many cases when access for acute dialysis is required early in a hospital course, at any age. PD catheter can be inserted with an open or laparoscopic approach. The complication rate after catheter insertion is still high, as reported in published literature. We present the experience matured at our Centre in the last 10 years on implantation of peritoneal dialysis catheters in children, emphasising surgical complications. We conducted a retrospective study on patients who underwent PD at our Centre in a range period of 10 years. We analysed patients ’demographic data, past and present medical, perioperative and post-operative data, permanence of the catheter, duration of dialysis, the gap between placement and use, outcomes and complications. We compared the data, dividing patients in 2 groups: patients operated with a traditional open technique and patients operated laparoscopically. We retrospectively reviewed 29 children with an average age of 3years and 6 months. Mean age was 42 months (1 month; 8 years) for the VLS group, 18 months (11 days, 4 years) for the OT group. Mean operative time was 106 min for the VLS group; 44 min for the OT group. The Catheter permanence period was 17 days (12h-64 days). Duration of dialysis was between 48 hours and 23 days (average 8 days). In the total population, we registered 8 complications (5 minor, 3 major), the overall complication rate being 33 % (minor complication rate 21%, major complication rate 12,5 %). 6 complications occurred in patients operated laparoscopically (6/14 = 36 %); 2 complications in the OT group (2/10 = 20 %). The complication rate after PD catheter insertion is still high. Advantages and disadvantages of the open and laparoscopic approach must be known. Both minor and major complications, such as bowel perforations and occlusions, must be understood and differentiated.
... 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). ...
Peritoneal dialysis is one of the three basic methods of renal replacement therapy. It allows the patient to perform dialysis at home while maintaining the basic principles of asepsis. It involves the permanent introduction of a dialysis catheter into the peritoneal cavity. Surgical procedure is not complicated, however, as any intervention may carry the risk of complications. Depending on the time of diagnosis, complications are divided into early, up to 30 days after surgery and late - over 30 days after surgery. This paper aims to present the most common surgical complications associated with Tenckoff catheter implantation.
... Surgical repair of the fistula may be needed. Most dialysis-associated perforations occur in the colon, followed by the cecum and rectum [1,2,[4][5][6], whereas perforation of the small intestine is rare. ...
... Rubin et al. [13] reported an incidence of perforation of 0.1% using the Moncrief and Popovich technique. Fujiwara et al. [6] emphasized that catheter-related intestinal perforation can be due to the presence of unused catheters, typically 1.6-48 months after the use has ceased. It is proposed that long duration of an immobile catheter in the peritoneal cavity containing little fluid may cause pressure necrosis of the bowel. ...
Background:
Intestinal perforation from peritoneal dialysis is rare, but the resulting complications are serious. Some patients do not necessarily have symptoms, and it can be difficult to differentiate their condition from PD-related (peritoneal dialysis-related) peritonitis, which may lead to misdiagnosis. Here we report a peritoneal dialysis patient with intestinal fistula associated with recurrent peritonitis.
Case presentation:
A 44-year-old man had been treated for more than 6 years with peritoneal dialysis for chronic kidney disease stage-V. Abdominal computed tomography and electronic colonoscopy revealed an appendiceal fossa with adjacent fistula. The peritoneal dialysis catheter was removed, and the patient recovered with no recurrence of complications.
Conclusion:
We report a case of a rare complication of peritoneal dialysis. The intestinal fistula in this patient was mainly caused by recurrent peritonitis and removal of the catheter could control the peritonitis.
... The small bowel is vulnerable to catheter-related perforation due to pressure necrosis. It is thought that dormant catheters may be at increased risk of bowel erosion, as there is no longer a fluid barrier between catheter and bowel [198]. Intraabdominal migration of the inner cuff, with adhesion to bowel, has also been implicated [199]. ...
... Intraabdominal migration of the inner cuff, with adhesion to bowel, has also been implicated [199]. Polycystic kidney disease, with raised intra-abdominal pressure, may also be a risk factor [198]. ...
... However, peritoneal dialysis is not free of problems. Some of its complications can make failures in function of the catheter including catheter mal-positioning, catheter migration and omental wrap around the catheter [3,4]. Catheter tip migration and omental wrapping are the most frequent laparoscopic finding in a patient who investigated for their malfunctioning catheter [5,6]. ...
Peritoneal dialysis is one of the types of renal replacement therapy which is commonly used in patients with the
end-stage renal disease. The cost-effectiveness and easy usage are the advantages of peritoneal dialysis. However,
peritoneal dialysis is not always free of a problem and among all of its complications, catheter tip migration and
omental wrapping are more common as are considered as the causes of catheter malfunctioning. Different
techniques are used to correct the malfunctioning catheters such as manipulator techniques, laparoscopic
repositioning with tip suturing, omentectomy and omentopexy. In this article, we are proposing two cases, which had
been referred by peritoneal catheter malfunctioning and then received a new method of surgery successfully and
didn’t have any complications after 36 months follow up. This method could simplify the procedure of operation and
urachus ligament and reduce time and cost of the process.
... There were some cases of atraumatic damage of the intraabdominal organ, such as spleen rupture, bowel erosion, and perforation. Retrospective studies of the serial changes of CT peritoneography in patients with symptomatic ultrafiltration failure have shown that retroperitoneal leakage, anterior abdominal wall leakage, and inguinal hernia can occur without trauma [12][13][14] . Intra-abdominal pressure in patients on PD can be changed depending on the patients' position, dialysate volume, and coughing. ...
Non-infectious complications of peritoneal dialysis (PD) are relatively less common than infectious complications but are a potentially serious problem in patients on chronic PD. Here, we present a case of a non-infectious complication of PD in a 13-year- old boy on chronic PD who presented with symptoms such as hypertension, edema, dyspnea, and decreased ultrafiltration. Chest and abdominal radiography showed pleural effusion and migration of the PD catheter tip. Laparoscopic PD catheter reposition was performed because PD catheter malfunction was suspected. However, pleural effusion relapsed whenever the dialysate volume increased. To identify peritoneal leakage, computed tomography (CT) peritoneography was performed, and a defect of the peritoneum in the left lower abdomen with contrast leakage to the left rectus and abdominis muscles was observed. He was treated conservatively by transiently decreasing the volume of night intermittent PD and gradually increasing the volume. At the 2-year follow-up visit, the patient had not experienced similar symptoms. Patients on PD who present with refractory or recurrent pleural effusion that does not respond to therapy should be assessed for the presence of infection, catheter malfunction, and pleuroperitoneal communication. Thoracentesis and CT peritoneography are useful for evaluating pleural effusion, and timely examination is important for identifying the defect or fistula.
A review from the last seven years (August 2016–July 2023) of questions posted to the International Society for Peritoneal Dialysis (ISPD) website “Questions about PD” by nurses and physicians from around the world revealed that 19 of the questions were associated with optimal approaches for preventing, assessing, and managing issues related to PD catheter non-infectious complications. Our review focused on responses to these questions whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practices discussed. We combined similar questions, revised both the original questions and responses for clarity, as well as updated the references to these questions. PD catheter non-infectious complications can often be prevented or, with early detection, the potential severity of the complication can be minimized. We suggest that the PD nurse is key to educating the patient on PD about PD catheter non-infectious complications, promptly recognize a specific complication and bring that complication to the attention of the Home Dialysis Team. The questions posted to the ISPD website highlight the need for more education and resources for PD nurses worldwide on the important topic of non-infectious complications related to PD catheters, thereby enabling us to prevent such complications as PD catheter malfunction, peri-catheter leakage and infusion or drain pain, as well as recognize and resolve these issues promptly when they do arise, thus allowing patients to extend their time on PD therapy and enhance their quality of life whilst on PD.
