Pneumoperitoneum Complicating Peritoneal Dialysis Catheter

Abstract

A 55-year-old male presented with progressively worsening nausea over a one-year period. It began when he started peritoneal dialysis for end-stage renal disease. His nausea progressed to the point that he could not tolerate oral intake. He also had difficulty with exchanges, but the exchange fluid was clear. He denied any fever, chills, abdominal pain, change in bowel movements, hematochezia, or hematemesis. The physical exam was unremarkable except for mild discomfort in the right lower quadrant. The peritoneal dialysis catheter was intact and appeared to be clean. The laboratory exam showed a normal white cell count and a negative peritoneal fluid culture. A KUB showed a large amount of free intra-peritoneal air. Further questioning of the patient revealed improper use of the peritoneal dialysis system as a cause of the pneumoperitoneum. The prevalence and clinical significance of pneumoperitoneum in peritoneal dialysis (PD) patients is not defined fully in the current literature. Some reports suggested that, unlike in nonPD patients, it rarely is caused by gastrointestinal perforation. 1 Intestinal perforation can be ruled out by rapid clinical improvement with standard therapy, growth of Staphylococcus epidermidis in the peritoneal effluent culture, reduction of pneumoperitoneum after correction of the technical fault, and in contrast to the Gram-negatives and/or anaerobes usually found during bowel perforation. 2-3