Abstract
The number of treated patients with peritoneal dialysis accounts for 2.8% of all kidney replacement therapy methods and constantly decreases. Peritoneal dialysis should be the first choice as the kidney function replacement treatment method in a transplantation waiting period. Besides all other possible infectious and mechanical complications of peritoneal catheter placement and maintenance, mechanical obstruction by ovarian fimbriae is very rare but potentially dangerous. We present four clinical cases (women 32–56 years) of mechanical obstruction of the peritoneal catheter by ovarian fimbriae during 2012–2014 in Clinical Hospital Merkur, Zagreb, Croatia. We use a laparoscopic technique with Čala trocar for peritoneal catheter placement in the right part of the Douglas cavity using a double-cuff Tenckhoff straight catheter. In our cases, all described obstructions were on the right side of the abdominal cavity. Only one patient had a displaced catheter. This problem was described only in a few case reports in which were presented with fluid exchange difficulties or initial vaginal secretion which can be easily mistaken for urinary incontinence. Mechanical complications connected with a peritoneal catheter can be successfully solved with laparoscopy intervention, which includes the ovary fimbriae obstruction.
Highlights
A global prevalence of chronic kidney disease (CKD) counts about 10–13%
Case reports We present four clinical cases of peritoneal catheter mechanical obstruction by ovarian fimbriae in Clinical Hospital Merkur, Zagreb during 2012–2014
The total mechanical obstruction of the peritoneal catheter by right ovarian fimbriae was confirmed with exploratory laparoscopy
Summary
A global prevalence of chronic kidney disease (CKD) counts about 10–13%. The exact data about CKD prevalence and its changes in Croatia do not exist. 8 mL of saline solution combined with 1 mL heparin was instilled into the catheter with no improvement One month after these complications, exploratory laparoscopy was done (Fig. 1). The CAPD procedure was started with 4 exchanges of 1.5 L fluid with a 1.5% glucose solution. The X-ray showed the malposition of the catheter, but the cause was not found on the exploratory laparoscopy procedure These complications were explained as right ovarian fimbriae leaning on the catheter perforations and the catheter was replaced. 4. Female 32 years After the catheter placement with no complications, in the nine months, the patient did not indicate starting the CAPD. The total mechanical obstruction of the peritoneal catheter by right ovarian fimbriae was confirmed with exploratory laparoscopy. The postoperative period was remarkable with no further complications in fluid exchange procedures
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