Abstract
BackgroundPeritonitis secondary to bowel perforation is a rare and potentially fatal complication in peritoneal dialysis (PD) patients. However, the early diagnosis of bowel perforation is difficult in PD patients because the initial symptoms and signs of bowel perforation are similar to those of PD-associated peritonitis. Furthermore, the risk of bowel perforation in PD patients is unclear. Here, we present a case of intestinal perforation located at the site of adhesive intestinal obstruction in a PD patient.Case presentationA 73-year-old man on PD presented with progressive worsening of abdominal pain and cloudy peritoneal fluid. The peritoneal fluid cell count was increased to 980/ml and peritoneal dialysis-associated peritonitis was diagnosed. Computed tomography showed local adhesions causing agglomeration of the dilated intestine. He initially responded to antibiotic treatment; however, his abdominal pain was rapidly worsened after resumption of oral intake. On hospital day 23, computed tomography showed loss of contents from the dilated intestine and discharge of fecal material from the PD tube was noted. Thus, small bowel perforation was diagnosed, and he underwent ileocecal resection with colostomy creation. As indicators of EPS was not evident, PD catheter was removed. Since then, he has been on maintenance of hemodialysis since then.ConclusionThe findings of the present case suggest that adhesive intestinal obstruction in PD patients can increase the risk of intestinal perforation. Careful monitoring for the early detection of intestinal perforation is required in such cases.
Highlights
Peritonitis secondary to bowel perforation is a rare and potentially fatal complication in peritoneal dialysis (PD) patients
The findings of the present case suggest that adhesive intestinal obstruction in PD patients can increase the risk of intestinal perforation
Conclusion the early diagnosis of intestinal perforation is obviously important for a better outcome, definitive signs of intestinal perforation are often lacking in PD patients
Summary
The early diagnosis of intestinal perforation is obviously important for a better outcome, definitive signs of intestinal perforation are often lacking in PD patients. EPS is rarely seen in patients with a long duration of PD therapy, and its major risk is highly associated with peritonitis episode [9, 10]. Despite long duration of PD therapy and local adhesions of the intestine, which resembled a cocoon, the indicators of EPS were not evident pathologically. Intestinal perforation in the present case was secondary to adhesive bowel obstruction, which is generally a major complication of intraperitoneal surgery [14]. Adhesive obstruction itself rarely leads to intestinal perforation in non-PD patients, it appears to be a risk factor for bacterial translocation associated with intraluminal hypertension. PD-associated peritonitis caused by bacterial translocation can make intestinal wall vulnerable because of infiltration of inflammatory cells, resulting in an increase in the risk of intestinal perforation in PD patients. Abbreviations B2M: Beta-2 microglobulin; CAPD: Continuous ambulatory peritoneal dialysis; CT: Computed tomography; EPS: Encapsulating peritoneal sclerosis; PD: Peritoneal dialysis
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