Chronic peritoneal dialysis in children: the role of ultrasound in the diagnosis of peritoneal catheter obstruction.

Abstract

Over the past two decades, continuous ambulatory peritoneal dialysis has emerged as the first-choice dialysis modality in children awaiting for transplantation. Despite the improvements observed in catheter survival over the past several years, the obstruction is one of the reasons for immediate catheter non-function. This study assessed usefulness of ultrasound (US) in visualizing the obstruction of chronic peritoneal dialysis (CPD) catheter and identifying the etiology. Between January 2000 and November 2012, 38 patients (20 M, 18 F) were treated with CPD and examined with US. The type of catheter in all subjects was the straight two-cuff Tenckhoff catheter. We evaluated the typical sonographic signs of the most common CPD catheter complications. We had 12/38 cases with catheter malfunction due to its obstruction. In eight patients, US showed the presence of echogenic material fragmented into the lumen and around the distal tip of the catheter. In the other four patients, US demonstrated the displacement of catheter in bowel loops and an amorphous material as homogeneous echoic area around the distal tip. Our results confirm the effectiveness of US in the assessment of the complications related to intraperitoneal catheters. US is able to identify the catheter obstruction and recognize the etiology (endoluminal strands of fibrin, other materials or the omental wrapping), facilitating a correct therapeutic approach.