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Delayed bowel perforation by a peritoneal dialysis catheter is a rare and uncommon complication.
Patients often present with signs and symptoms of peritonitis and watery diarrhea during PD inflow. Some patients do not have any symptoms especially if they have dormant PD catheters. Most common site: COLON >> RECTUM and CAECUM. Incidence:0.1-0.2% Mortality rate: 46-57%.
15 year old boy, known case of End Stage Renal Disease on Continuous Ambulatory Peritoneal Dialysis (CAPD) of vintage 6 months, presented with complaints of Abdominal pain, Poor catheter outflow, Reduction in drain volume Watery diarrhea within minutes of dwell initiation for about 10 days.
CAPD HISTORY:
2-cuffed, straight neck, straight tip soft Tenckhoff catheter inserted by open surgical method 6 months prior to this presentation. Initiated on Automated peritoneal dialysis using cycler on day 4 and total 2 sessions of 24 hour cycles were done on day 4 and 8.
CAPD CYCLES PRESCRIBED:
TWO 1000ml 1.5% D DAY DWELLS
ONE 1000ML 2.5% D NIGHT DWELL
2 months prior to this presentation, patient was admitted with abdominal pain, fever with chills and rigors; evaluated with drain fluid TLC and DLC; CULTURE AND SENSITIVITY. Diagnosed to have CULTURE NEGATIVE PERITONITIS, for which he was treated with empirical antibiotics IV (PIPERACILLIN-TAZOBACTAM and Intra peritoneal VANCOMYCIN). Cultures were negative on day 3, 7 and 14. Mean while, patient improved; attender was re-trained and patient was discharged.
EVALUATION:
Methylene blue added to peritoneal dialysate was infused into patient peritoneal cavity and documented perianal bluish gush in 5-6 minutes of infusion.
CT catheterography was done to document level of bowel perforation, and it was suggestive of catheter perforating bowel at recto-sigmoid junction.
Patient was treated with broad spectrum antibiotics and IV metronidazole and intermittent hemodialysis. Exploratory laparotomy and fistula tract excision was done.