Abstract
IntroductionPerforative peritonitis in patients on peritoneal dialysis (PD) is a serious adverse event associated with significant mortality. The signs and symptoms of perforative peritonitis in patients on PD are often confused with those of PD-related peritonitis; therefore, early diagnosis is often difficult. Presentation of casesIn all three cases, antibiotic therapy was started for peritonitis. Although contrast-enhanced computed tomography (CT) was not performed, perforative peritonitis was suspected due to severe cloudiness of PD effluents, and emergency surgeries were performed 8, 5, and 6 days after therapy onset in cases 1, 2, and 3, respectively. In case 1, the ileum was perforated owing to ischemia, and partial ileal resection and divided ileostomy were performed. The patient died 18 days postoperatively. In case 2, partial ileal resection and divided ileostomy were performed for an incarcerated obturator hernia and perforated ileum. The patient was transferred for hemodialysis (HD) and discharged 117 days postoperatively. In case 3, lavage drainage was performed for peritonitis because of mesenteric penetration of a sigmoid colon diverticulum. The patient was then transferred for HD, and colostomy was subsequently performed. He was discharged 159 days postoperatively. DiscussionEarly diagnosis between PD-related peritonitis and perforative peritonitis is often difficult since the washing effect of the peritoneal dialysate might relieve peritoneal irritation. ConclusionIn PD patients with refractory peritonitis, it is necessary to keep in mind the possibility of perforative peritonitis, and the differential diagnosis should be performed using contrast-enhanced CT within at least 5 days after antibiotic therapy.
Highlights
Perforative peritonitis in patients on peritoneal dialysis (PD) is a serious adverse event associated with significant mortality
Despite the need for appropriate surgical intervention, early diagnosis of perforative peritonitis is difficult because the washing effect of the peritoneal dialysate might relieve peritoneal irritation [3]
On inspection of the abdominal cavity, ischemic changes and partial perforation were observed in the ileum; he was diagnosed with perforative peritonitis associated with ischemic enteritis (Fig. 1b)
Summary
Perforative peritonitis in patients on peritoneal dialysis (PD) is a serious adverse event associated with significant mortality. The signs and symptoms of perforative peritonitis in patients on PD are often confused with those of PD-related peritonitis; early diagnosis is often difficult. In case 1, the ileum was perforated owing to ischemia, and partial ileal resection and divided ileostomy were performed. In case 2, partial ileal resection and divided ileostomy were performed for an incarcerated obturator hernia and perforated ileum. The patient was transferred for hemodialysis (HD) and discharged 117 days postoperatively. The patient was transferred for HD, and colostomy was subsequently performed CONCLUSION: In PD patients with refractory peritonitis, it is necessary to keep in mind the possibility of perforative peritonitis, and the differential diagnosis should be performed using contrast-enhanced CT within at least 5 days after antibiotic therapy
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