Refractory peritonitis by spontaneous perforation of the common bile duct in a patient receiving peritoneal dialysis

Abstract

BackgroundPatients with end-stage renal disease are in an immune-compromised state, with infection being the most common cause of mortality among those undergoing dialysis.Case presentationA 73-year-old woman who had received 6 months of peritoneal dialysis (PD) presented with peritoneal irritation symptoms during hospitalization for examination of PD effluent turbidity. Emergent laparotomy was performed for acute biliary peritonitis, but the cause was undetermined because of severe adhesion, and surgery ended with washing and palliative drainage. Postoperative endoscopic retrograde cholangiopancreatography revealed spontaneous perforation of the common bile duct (CBD), and she was transferred to the intensive care unit (ICU) for treatment of septic shock. Treatment included antibiotics, drainage, mechanical ventilation, and continuous hemodiafiltration, but infection spread into the retroperitoneal tissue and right thigh gradually. On ICU day 53, she died due to multiple organ failure.ConclusionsAcute peritonitis due to spontaneous perforation of the CBD is very rare, and to our knowledge, this is the first report of biliary peritonitis in a patient receiving PD. Physicians should pay special attention to refractory peritonitis, including biliary peritonitis, occurring in patients receiving PD because some cases can be fatal.