Abdominal wall hernia during peritoneal dialysis

Abstract

A 58-year-old female receiving continuous ambulatory peritoneal dialysis presented with a two-month history of indigestion. She had chronic renal failure related to a 21-year history of hypertension, and was treated with continuous ambulatory peritoneal dialysis using 4 2 l exchanges of peritoneal dialysis fluid daily, which had been initiated 17 months earlier. A Tenckhoff catheter was implanted via a classic transverse surgical incision. No episode of peritonitis after the start of dialysis was reported. The examination showed a 1.5-cm-sized, soft, manually reducible subumbilical swelling at the site of the peritoneal entry of the Tenckhoff cannula and normal abdominal auscultation without peritoneal irritation. The standard abdominal X-ray (Figure 1) revealed mildly dilated loops of the small and large bowels without fecal impaction. The computed tomography scan of the abdomen (Figure 2) revealed herniation of the small bowel through the peritoneal entry site of the Tenckhoff catheter, which caused the obstructive ileus of the small bowel. There were no necrotic changes to the small bowel. The hernia was repaired, the cannula tip was reinserted, and dialysis was restarted without complications. Most hernias in patients on CAPD are asymptomatic; therefore, they can be missed if not carefully explored. Umbilical and inguinal hernias are the most common, and pericatheter herniation is extremely rare. 1,2 Because it can be a serious complication of CAPD, prompt treatment is needed to prevent life-threatening complications such as bowel incarceration. 2