Arata R, Banshodani M, Yamashita M, Shintaku S, Moriishi M, Kawanishi H. Perforative peritonitis confused with peritoneal dialysis-related peritonitis: Report of three cases.
Int J Surg Case Rep 2020;
70:20-23. [PMID:
32361606 PMCID:
PMC7193318 DOI:
10.1016/j.ijscr.2020.03.046]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 11/30/2022] Open
Abstract
Intestinal perforation in patients on peritonitis dialysis (PD) has high mortality.
Perforative peritonitis in PD patients and PD-associated peritonitis patients have similar signs.
Rapid diagnosis can help exclude perforation in cases of refractory peritonitis.
Introduction
Perforative peritonitis in patients on peritoneal dialysis (PD) is a serious adverse event associated with significant mortality. The signs and symptoms of perforative peritonitis in patients on PD are often confused with those of PD-related peritonitis; therefore, early diagnosis is often difficult.
Presentation of cases
In all three cases, antibiotic therapy was started for peritonitis. Although contrast-enhanced computed tomography (CT) was not performed, perforative peritonitis was suspected due to severe cloudiness of PD effluents, and emergency surgeries were performed 8, 5, and 6 days after therapy onset in cases 1, 2, and 3, respectively. In case 1, the ileum was perforated owing to ischemia, and partial ileal resection and divided ileostomy were performed. The patient died 18 days postoperatively. In case 2, partial ileal resection and divided ileostomy were performed for an incarcerated obturator hernia and perforated ileum. The patient was transferred for hemodialysis (HD) and discharged 117 days postoperatively. In case 3, lavage drainage was performed for peritonitis because of mesenteric penetration of a sigmoid colon diverticulum. The patient was then transferred for HD, and colostomy was subsequently performed. He was discharged 159 days postoperatively.
Discussion
Early diagnosis between PD-related peritonitis and perforative peritonitis is often difficult since the washing effect of the peritoneal dialysate might relieve peritoneal irritation.
Conclusion
In PD patients with refractory peritonitis, it is necessary to keep in mind the possibility of perforative peritonitis, and the differential diagnosis should be performed using contrast-enhanced CT within at least 5 days after antibiotic therapy.
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