S3533 Tenckoff Catheter Rectal Perforation Presenting as GI Bleeding

Abstract

Introduction: Peritoneal dialysis catheter erosion into the bowel is a very rare, late complication of peritoneal dialysis. Clinical presentation can range from asymptomatic to features of peritonitis. With only a few case reports in existence there is no consensus on management. The following is a case of patient on long-term peritoneal dialysis, presenting with rectal bleeding, found to have a dialysis catheter eroding into the rectum. Case Description/Methods: 81-year-old man with a history of ESRD on peritoneal dialysis, initially presented with abdominal pain and bloody stools. Colonoscopy revealed old blood with several polyps, but no active bleeding. CT angiography with embolization to control right colonic bleeding was unsuccessful. The patient underwent right hemicolectomy. Intraoperatively, the Tenckhoff catheter was positioned in the cul-de-sac and the patient was started on hemodialysis. Two months later the patient was readmitted for hematochezia with hemodynamic instability. Repeat colonoscopy showed old blood throughout the colon, including the terminal ileum and the presence of a Tenckhoff catheter inside the rectum. EGD was unremarkable. He taken to the OR for an exploratory laparotomy with intraoperative colonoscopy. The Tenckhoff catheter was removed by the surgeon, and an over-the-scope (OVESCO) clip was applied to close the defect. Discussion: Delayed peritoneal catheter perforation is a late complication that occurs more commonly in patients with dormant catheters. These patients lack the constant lubricating effect of the dialysate on the bowel. When peritoneal dialysis is stopped, the catheter exerts constant pressure on the intestinal wall, causing ischemia, and perforation. Since this is a slow process, it rarely causes bleeding. The most common presentations are aqueous diarrhea with dialysate instillation, and peritonitis. Less commonly patients may present with catheter protrusion through the anus and bleeding. Because the incidence of delayed peritoneal catheter perforations is very low, there is no established guidelines on management. Most approaches are surgical interventions with catheter removal and defect repair.Figure 1.: Peritoneal dialysis catheter eroded into the rectum.