LARGE BOWEL EROSION BY A FUNCTIONING PERITONEAL DIALYSIS CATHETER: A RARE COMPLICATION

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LARGE BOWEL EROSION BY A FUNCTIONING PERITONEAL DIALYSIS CATHETER: A RARE COMPLICATION

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Co-author 1

Melchor Jr. Eda melchor_eda@yahoo.com Bicol Medical Center Internal Medicine, Section of Adult Nephrology Naga City Philippines *

Co-author 2

Lara Mea Barrameda larabarrameda@gmail.com Bicol Medical Center Internal Medicine, Section of Adult Nephrology Naga City Philippines -

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Introduction

Continuous ambulatory peritoneal dialysis (CAPD) is a widely used renal replacement therapy that offers hemodynamic stability, better lifestyle flexibility, and favorable metabolic outcomes. Although peritonitis and catheter malfunction are common complications, erosion of the catheter tip into the bowel is extremely rare and often reported only anecdotally. We report a case of large bowel erosion by a functioning peritoneal dialysis (PD) catheter following an alleged blunt trauma in a stable end-stage renal disease (ESRD) patient.

Methods

This is a single-patient descriptive case report. Clinical presentation, course, imaging findings, microbiologic results, and management were detailed based on hospital chart review and imaging documentation. Abdominal computed tomography (CT) with simultaneous intraperitoneal dialysate-contrast infusion was used to confirm catheter position.

Results

A 70-year-old male with ESRD on CAPD for seven months, previously asymptomatic, presented with a one-week history of poor peritoneal drain and profuse diarrhea occurring immediately after each dialysis exchange, following an alleged transport-related jolt. He was afebrile and without signs of peritonitis. Abdominal CT revealed the PD catheter tip eroding into the sigmoid colon. The catheter was removed bedside under local anesthesia; the catheter tip culture grew E. coli and Proteus mirabilis, and the patient was treated with intravenous antibiotics. No postoperative complications occurred. He was safely transitioned to thrice-weekly hemodialysis.

Abdominal radiograph showing the coiled PD catheter tip within the pelvic cavity (red arrow).

Figure 1. Abdominal radiograph showing the coiled PD catheter tip within the pelvic cavity (red arrow).

Figure 2. Abdominal CT scan, sagittal view, demonstrating the radiopaque (A) and hyperdense (B) PD catheter traversing the anterior abdominal wall and coursing through the peritoneal cavity at the level of the S3 vertebra (red arrows).

Large bowel erosion by a functioning CAPD catheter is a rare complication, most often reported within weeks of catheter insertion. It commonly presents with peritonitis or profuse diarrhea, although symptoms may be absent. Blunt abdominal trauma may accelerate or unmask subclinical catheter erosion. Conservative catheter removal with antibiotic therapy is appropriate in clinically stable patients. Patient education on travel-related precautions is essential, particularly in regions where CAPD patients frequently commute long distances.

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