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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
Laparoscopic Tenckhoff catheter placement is a common technique for peritoneal dialysis (PD), allowing optimal catheter positioning under direct vision. To prevent catheter migration, a subcutaneous tunnel is typically created close to the abdominal muscle. However, this tunneling step is performed blindly without laparoscopic visualization, creating potential risk for inadvertent secondary peritoneal perforation. This complication can lead to persistent dialysate leakage and technique failure. We describe two cases of unrecognized secondary peritoneal perforation to highlight the diagnostic approach and management strategy.
We present a case series of two patients with end stage renal disease (ESRD) who underwent laparoscopic Tenckhoff catheter placement. Both developed persistent pericatheter dialysate leakage refractory to conservative management (reduced fill volumes, temporary PD hold). Both underwent contrast-enhanced CT peritoneography. Based on imaging findings, surgical exploration and repair were performed.
Case 1: A 70-year-old female with ESRD secondary to hypertension and satisfactory nutritional status underwent uneventful laparoscopic Tenckhoff placement. Two weeks post-surgery, she started APD with conservative volume escalation: 1000 mL/cycle for 4 cycles, increasing 200 mL every 2 days. At 1400 mL/cycle, significant pericatheter leakage developed, markedly exacerbated when sitting and improved when supine. Four weeks of conservative management (1200 mL/cycle, 6-hour dwells, supine position) were unsuccessful, with leakage recurring upon volume increase or sitting. CT peritoneography demonstrated a Tenckhoff catheter with its subcutaneous tract coursing adjacent to the abdominal wall musculature, showing inadvertent secondary entry into the peritoneal cavity; a small volume of contrast outlines the catheter intraperitoneally and tracks along the subcutaneous segment to the cutaneous exit site.
Case 2: A 65-year-old male with ESRD due to ANCA-associated vasculitis had laparoscopic Tenckhoff placement. Two days postoperatively, during a routine catheter flush, he developed immediate fluid leakage from the exit site, occurring instantly upon fluid instillation regardless of posture. After a two-week rest without improvement, he transitioned to hemodialysis for one month with weekly dressing changes, but leakage persisted. CT peritoneography demonstrated the Tenckhoff catheter tunnel lying adjacent to the abdominal oblique musculature, with a segment traversing the muscle and re-entering the peritoneal cavity; the peritoneal defect measures approximately 2 cm. A small volume of contrast extravasation is seen at the left flank peritoneal defect site, tracking along the subcutaneous catheter tunnel.
Both cases underwent surgical intervention, confirming the radiological diagnosis with successful catheter salvage and enabling continuation of PD therapy.
Inadvertent peritoneal perforation during blind subcutaneous tunneling is a significant but underrecognized mechanical complication of laparoscopic Tenckhoff catheter placement. This structural defect renders conservative management ineffective. A high index of suspicion is warranted for persistent dialysate leakage. CT peritoneography is invaluable for confirmation, while surgical repair provides necessary and definitive treatment to resolve the issue and prevent catheter removal.
