Abdominal pseudocysts following peritoneal dialysis-associated peritonitis: a report of 3 cases

Intra-Peritoneal Pseudocyst as a Rare Complication After Peritoneal Dialysis: The Use of a Staged Surgical Approach in Management

Despite its numerous benefits, peritoneal dialysis (PD) can rarely result in dangerous and even life-threatening complications, including peritonitis, hernias, encapsulating peritoneal sclerosis (EPS), and rarely peritoneal pseudocysts. Herein, we present a rare case of a giant intra-peritoneal pseudocyst that presented four months following the discontinuation of a 5-year course of complicated PD. Despite the initially successful drainages, the patient's symptoms continued to recur, and the imaging findings were concerning for underlying neoplastic processes. As such, a staged surgical approach was performed, starting with a diagnostic laparoscopy and was subsequently followed with cyst excision and marsupialization to the peritoneal cavity. While previous reports of such rare pseudocyst have been documented in the literature as a complication of PD, to our knowledge, this is the second case of pseudocyst formation to occur months after the discontinuation of PD therapy. This case emphasizes the importance of close follow-up in PD patients and showcases how a staged surgical approach can be utilized to accurately diagnose and manage such complicated cases.

Recurrent Peritoneal Pseudocyst: A Rare Complication of Peritoneal Dialysis

An alarming 468,000 people are dependent on dialysis for their end-stage renal disease (ESRD) management in the United States alone. Peritoneal dialysis is a preferred type of dialysis over hemodialysis, considering its initial survival advantage, patient satisfaction, and cost-effectiveness. One of the rare complications of peritoneal dialysis is abdominal and peritoneal pseudocyst formation. Literature regarding the accurate medical management of such peritoneal pseudocysts is scarce. Adding to this, management of recurrent loculated, non-malignant peritoneal pseudocyst poses to be challenging especially when pseudocysts recur after the offending peritoneal dialysis catheter is removed.

We report one such case of a patient with a history of ESRD managed on long-term peritoneal dialysis. He presented to the hospital with recurrent abdominal pain which was treated multiple times for spontaneous bacterial peritonitis. Due to recurrence, his peritoneal dialysis was discontinued and hemodialysis was initiated. While on hemodialysis and two years after peritoneal dialysis catheter removal, he presented with sudden onset abdominal distension. Imaging showed loculated peritoneal pseudocyst with multiple loculations. Standard recommendation of surgical removal of cyst could not be performed in this patient due to his coexisting medical co-morbidities. Interventional radiology (IR) guided cyst drainage was attempted but was limited due to multiple locutions. However, IR drainage proved to provide temporary relief and after repeated IR guided drainage, a temporary drainage tube was placed. This subsided the recurrence of fluid-filled pseudocysts and the patient improved.

This case emphasizes the importance of follow up of patients who have been or currently are on peritoneal dialysis for early recognition of late-onset complications. Our case also shows the routine challenges faced by the clinician when rare complications arise and standard treatment options cannot be applied.