Hemoperitoneum in Peritoneal Dialysis Secondary to Retroperitoneal Hematoma

Abstract

Editor: Hemoperitoneum is an unusual complication in patients undergoing CAPD (1). In most cases it has a benign course. Two milliliters of blood can dye the peritoneal effluent an intense red. The most frequent cause is endometriosis. However, other gynecological, hematological, tumoral, and abdominal sources can cause hemoperitoneum. Polycystic kidney disease, peritonitis, pancreatitis, cholecystitis, and extracorporeal lithotripsy are other possibilities. Rarely, hemoperitoneum is associated with rupture of the spleen (2) or iliopsoas spontaneous hematoma (3). We present a case of hemoperitoneum consequent to retroperitoneal hematoma after manipulating a double-lumen femoral catheter for hemodialysis. This 44-year-old woman with systemic lupus erythematosus and end-stage renal disease has been on hemodialysis for the last three years. Because of thrombosis of every possible vascular access site, it was decided to change her to peritoneal dialysis. A left Swan neck Missouri peritoneal catheter was placed by surgical technique without complication. A peritoneal lavage at the seventh and fourteenth day was clear. The patient continued on hemodialysis through a doublelumen femoral catheter on the right side. We waited four weeks before standard CAPD was begun. Seventeen days after placement of the peritoneal catheter, during a hemodialysis session, her femoral catheter was changed through a guide wire because of poor flow. Suddenly, she developed severe pain in the right lumbar fossa, right hemiabdomen, and acute anemia and hypovolemic shock occurred. The femoral catheter was removed, and she received intravenous fluids and transfusion of six packed red blood cells, achieving hematologic and hemodynamic stabilization. No surgery was required. A computed tomography scan of the abdomen showed retroperitoneal hematoma involving the right anterior and posterior pararenal space and right iliopsoas muscle. Twenty-four hours later, nightly intermittent peritoneal dialysis was begun. The first peritoneal effluent was very bloody. After continuous peritoneal lavage with 1-L exchanges at room temperature over two hours, the dialysate became clear. One year later, the patient continues on continuous cycling peritoneal dialysis without any problems. To our knowledge, this cause of hemoperitoneum has not been reported before. Therefore, we believe that retroperitoneal hematoma secondary to hemodialysis with a femoral catheter may be listed in the causes of hemoperitoneum in peritoneal dialysis. F. Fernandez Giron F. Hermosilla Sanchez M. Paralle Alcalde J. Gonzalez Martinez