Abdominal Distention in a Patient on Peritoneal Dialysis.

Abstract

A 66-year-old Caucasian man with a failing cardiac transplant, transfusion-dependent myelodysplastic syndrome, and ESKD from calcineurin inhibitor toxicity on peritoneal dialysis (PD) was admitted with complaints of acute onset of shortness of breath after suspected aspiration, and progressive abdominal distention. Physical examination revealed crepitations in the right lung base and distended abdomen that was dull on percussion in the flanks, as well as bilateral inguinal hernias. Chest x-ray confirmed right lower lobe patchy pneumonitis consistent with aspiration along with mild cardiomegaly. Because his symptoms persisted despite antibiotics and achieving daily ultrafiltration in excess of 1 L with PD, a computed tomography (CT) abdomen scan with oral contrast was performed that showed extensive …