The Case ∣ Adynamic ileus after insertion of peritoneal dialysis catheter

Delayed Erosion of Peritoneal Dialysis Catheter Tip into the Small Bowel

Catheter erosion into the small bowel is an uncommonly reported complication of continuous ambulatory peritoneal dialysis (CAPD). This can result in peritonitis, sepsis, fistula formation, and mortality. We report a 29-year-old female with end-stage renal disease presenting with nausea, profuse diarrhea immediately after dialysate instillation, change in color and odor of the dialysis output, and pain at the site of her peritoneal dialysis (PD) catheter. After a thorough evaluation, catheter tip erosion into the patient's small bowel lumen was diagnosed. This was confirmed when a blue bowel movement followed instillation of a saline solution with methylene blue into the dialysis catheter. A laparoscopic-assisted procedure was performed with removal of the dialysis catheter, resection of the diseased small bowel, and insertion of a right internal jugular tunneled dialysis catheter. Small bowel biopsy was benign. Post-operatively, the patient had no complications, was started on hemodialysis, and was discharged home.

Peritoneal Dialysis Catheter Insertion

The success of peritoneal dialysis as renal-replacement therapy depends on a well-functioning peritoneal catheter. Knowledge of best practices in catheter insertion can minimize the risk of catheter complications that lead to peritoneal dialysis failure. The catheter placement procedure begins with preoperative assessment of the patient to determine the most appropriate catheter type, insertion site, and exit site location. Preoperative preparation of the patient is an instrumental step in facilitating the performance of the procedure, avoiding untoward events, and promoting the desired outcome. Catheter insertion methods include percutaneous needle-guidewire with or without image guidance, open surgical dissection, peritoneoscopic procedure, and surgical laparoscopy. The insertion technique used often depends on the geographic availability of material resources and local provider expertise in placing catheters. Independent of the catheter implantation approach, adherence to a number of universal details is required to ensure the best opportunity for creating a successful long-term peritoneal access. Finally, appropriate postoperative care and catheter break-in enables a smooth transition to dialysis therapy.