Report of laparoscopic findings in refractory peritonitis in peritoneal dialysis patients

【Background】 There are no reports of laparoscopic findings in peritoneal dialysis (PD)-related peritonitis. We have previously reported laparoscopic imaging findings at the end of PD (KI Reports 2016, Semin Dial 2020, Nephrology 2023).

【Method】 We investigated laparoscopic findings observed during catheter removal and reinsertion for intractable peritonitis at our hospital. We present and report the findings along with their imaging findings.

【Results】 Intraperitoneal findings were variable. In cases of Mycobacterium/MRSA, strong pseudo membrane formation and adhesions were observed, and differences in localization and severity were observed. In all cases several years had passed without complications of encapsulateted peritoneal sclerosis. In the case of Corynebacterium, there was almost no evidence of inflammatory changes in the abdominal cavity, and PD was reintroduced 2 months later. In the case of Pseudomonas aeruginosa, there were strong signs of intraperitoneal adhesions and fibrin occlusion, which led to the removal of the PD catheter. Three years later, due to the patient's strong desire to restart PD, laparoscopic observation showed that the adhesions were improving over time and were easy to remove with forceps, so PD was reintroduced. However, due to insufficient water removal, the patient was used in PD+HD combination therapy.

【Conclusion】 Although it is difficult to infer the intraperitoneal cavity from clinical findings, we believe that the decision to re-place a PD catheter should be made carefully in cases of peritonitis that exhibit strong inflammatory changes. Laparoscopic findings at the time of PD catheter removal in patients with refractory peritonitis may be helpful in evaluating the possibility of restarting PD.