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Yen CC, Chang WC, Chang CW. Silent Hemoperitoneum Unveils Advanced Cancer. Cureus 2024; 16:e64494. [PMID: 39139321 PMCID: PMC11319834 DOI: 10.7759/cureus.64494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2024] [Indexed: 08/15/2024] Open
Abstract
A 62-year-old male undergoing peritoneal dialysis (PD) for over two years presented with sudden bloody peritoneal dialysate, but no other symptoms. Laboratory tests indicated anemia, and a computed tomographic scan revealed a 4.4 cm tumor in the liver with hemoperitoneum, leading to a diagnosis of ruptured hepatocellular carcinoma (HCC), stage IIIB T4N0M0. The patient underwent a successful laparoscopic segmentectomy, and PD was resumed after a month of hemodialysis without complications. This case underscores the importance of considering malignancy in PD patients presenting with hemoperitoneum, as timely detection of HCC can significantly improve prognosis.
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Affiliation(s)
- Cheng-Chieh Yen
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, TWN
| | - Wan-Chen Chang
- Peritoneal Dialysis Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, TWN
| | - Chieh-Wei Chang
- Division of General Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, TWN
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2
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Managing Hospitalized Peritoneal Dialysis Patients: Ten Practical Points for Non-Nephrologists. Am J Med 2021; 134:833-839. [PMID: 33737056 DOI: 10.1016/j.amjmed.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/31/2021] [Accepted: 02/06/2021] [Indexed: 01/08/2023]
Abstract
Although nephrologists are responsible for the long-term care of dialysis patients, physicians from all disciplines will potentially be involved in the management of patients with kidney failure, including patients on peritoneal dialysis, the major home-based form of kidney-replacement therapy. This review aims to fill knowledge gaps of non-experts in peritoneal dialysis and to highlight key management aspects of in-hospital care of patients on peritoneal dialysis, with a focus on acute scenarios to facilitate prompt decision-making. The clinical pearls provided should enable non-nephrologists to avoid common pitfalls in the initial assessment of peritoneal dialysis-related complications and guide their decision regarding when to refer their patients to a specialist, resulting in improved multidisciplinary patient care.
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3
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Goel N, Haddad DB, Jain D. Hemoperitoneum After Cardiopulmonary Resuscitation in Peritoneal Dialysis Patients: A Tale of Two Cases. Int J Nephrol Renovasc Dis 2020; 13:379-383. [PMID: 33364811 PMCID: PMC7751573 DOI: 10.2147/ijnrd.s285969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/03/2020] [Indexed: 01/10/2023] Open
Abstract
End-stage renal disease (ESRD) patients are at much higher risk of cardiac arrest as compared to the general population. In the event of a cardiac arrest, cardiopulmonary resuscitation (CPR) is a lifesaving procedure. In fact, the need for CPR among hospitalized ESRD patients is almost 20 times higher than the general population. Complications of CPR include thoracic injuries such as flail chest, rib fractures, pneumothorax, and rarely intra-abdominal complications. Hemoperitoneum is a well-recognized complication among peritoneal dialysis patients but as a complication of CPR is rarely described. Inappropriate CPR technique, hepatic ischemia and venous congestion, platelet dysfunction, and the use of anti-platelet agents can increase the risk of such injury and bleeding. Hemoperitoneum in this setting can be serious with significant complications and may require transition from peritoneal dialysis (PD) to hemodialysis. We report two such PD patients who developed hemoperitoneum as a complication after CPR and their course.
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Affiliation(s)
- Narender Goel
- New Jersey Kidney Care, Jersey City, NJ, USA.,Division of Nephrology, CarePoint Health Hospitals, Jersey City, NJ, USA.,Division of Nephrology, RWJ Barnabas Jersey City Medical Center, Jersey City, NJ, USA
| | - Danny B Haddad
- New Jersey Kidney Care, Jersey City, NJ, USA.,Division of Nephrology, CarePoint Health Hospitals, Jersey City, NJ, USA.,Division of Nephrology, RWJ Barnabas Jersey City Medical Center, Jersey City, NJ, USA
| | - Deepika Jain
- New Jersey Kidney Care, Jersey City, NJ, USA.,Division of Nephrology, CarePoint Health Hospitals, Jersey City, NJ, USA.,Division of Nephrology, RWJ Barnabas Jersey City Medical Center, Jersey City, NJ, USA
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4
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Yılmaz F, Bora F, Çetinkaya R, Gelen MT, Süleymanlar G, Ersoy F. A case of cyclic hemoperitoneum in a hemodialysis patient: Encapsulated peritoneal sclerosis complicated by endometriosis and fungal peritonitis. Semin Dial 2020; 34:176-179. [PMID: 33349976 DOI: 10.1111/sdi.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Encapsulated peritoneal sclerosis (EPS) is a rare, but frequently fatal, long-term complication of peritoneal dialysis. Endometriosis is a common gynecological problem but hemoperitoneum due to endometriosis has been reported to be extremely rare in hemodialysis (HD) patients. A 25-year-old female HD patient was admitted to our clinic with nausea, vomiting, abdominal pain, and weight loss for last 3 months. Candida tropicalis and Candida glabrata were isolated in the fungal cultures from peritoneal fluid. Her abdominal computerized tomography scan has shown irregular peritoneal calcifications, diffuse peritoneal thickening, dilatation of the small bowel loops, and cocoon formation which all were typical for EPS. Hemoperitoneum was reported to recur for four times with intervals suggesting menstrual cycles. Her peritoneal biopsy, along with the signs of EPS, has also revealed the presence of endometriosis. The patient died with symptoms of septic shock in the first year of EPS diagnosis.
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Affiliation(s)
- Fatih Yılmaz
- Department of Nephrology, Antalya Ataturk State Hospital, Antalya, Turkey
| | - Feyza Bora
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
| | - Ramazan Çetinkaya
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
| | | | - Gültekin Süleymanlar
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
| | - Fevzi Ersoy
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
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5
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Lew SQ, Khan AA, Rieders B, Agrawal ST. Haemoperitoneum after an endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of a pancreatic lesion in a peritoneal dialysis patient. BMJ Case Rep 2020; 13:13/11/e236573. [PMID: 33148597 DOI: 10.1136/bcr-2020-236573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Haemoperitoneum was observed in a peritoneal dialysis (PD) patient after undergoing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). EUS-FNA was performed to evaluate a pancreatic cyst seen on a prekidney transplant evaluation abdominal CT scan. Haemoperitoneum cleared with a PD exchange. In this case report, we discuss aetiologies for bleeding risks in patients with chronic kidney disease and focus on haemoperitoneum in patients receiving PD. We will also explore treatment options to minimise bleeding associated with an abdominal procedure such as EUS-FNA.
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Affiliation(s)
- Susie Q Lew
- Medicine, George Washington University, Washington, District of Columbia, USA
| | - Ali A Khan
- Medicine, George Washington University, Washington, District of Columbia, USA
| | - Brandon Rieders
- Medicine, George Washington University, Washington, District of Columbia, USA
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Kohn OF, Culbertson S, Becker YT. Hemoperitoneum in a Peritoneal Dialysis Patient: Ruptured Ectopic Pregnancy. Perit Dial Int 2019; 38:455-456. [PMID: 30413637 DOI: 10.3747/pdi.2018.00066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Hemoperitoneum is a well-recognized complication in female peritoneal dialysis (PD) patients of childbearing age. Bloody effluent is commonly of minor nature, presenting during menstruation or midcycle, resolving after a few rapid exchanges without a need for further intervention. One must remain vigilant, however, and consider a broader differential diagnosis when hemoperitoneum is persistent or severe, as it indicates a serious and potentially life-threatening etiology. We report 2 episodes of hemoperitoneum in a PD patient occurring more than 1.5 years apart, with different underlying etiologies. The more dramatic second episode was due to a ruptured ectopic pregnancy, a condition which had not been reported as a cause of hemoperitoneum in dialysis patients to date and requires a high index of suspicion and prompt surgical intervention.
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Affiliation(s)
- Orly F Kohn
- Nephrology, University of Chicago, Chicago, IL, USA
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8
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Dossin T, Goffin E. When the color of peritoneal dialysis effluent can be used as a diagnostic tool. Semin Dial 2018; 32:72-79. [DOI: 10.1111/sdi.12740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Dossin
- Department of Nephrology; Centre Hospitalier Universitaire Lapeyronie; Montpellier France
- Department of Nephrology; Université catholique de Louvain; Cliniques Universitaires Saint Luc; Brussels Belgium
| | - Eric Goffin
- Department of Nephrology; Université catholique de Louvain; Cliniques Universitaires Saint Luc; Brussels Belgium
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Laparoscopic peritoneal dialysis catheter insertion using nitrous oxide under procedural sedation. World J Surg 2015; 39:128-32. [PMID: 25189449 DOI: 10.1007/s00268-014-2761-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Laparoscopic peritoneal dialysis catheter (LPDC) implantation using nitrous oxide (N2O) pneumoperitoneum under procedural sedation is a technique that has many advantages over conventional insertion methods. The purpose of this study was to review the LPDC insertion results at our center. METHODS Data from 87 consecutive patients who underwent LPDC insertion was retrospectively reviewed. All procedures were attempted under procedural sedation. After patients received intravenous and local anesthesia, a N2O pneumoperitoneum was established. Peritoneal dialysis (PD) catheters were advanced using rectus sheath tunneling. The position of the catheter was confirmed by laparoscope, and adjunct procedures such as omentopexy and adhesiolysis were performed on select patients to prevent catheter flow problems. RESULTS Nitrous oxide was well tolerated by 94 % of the patients. Only five patients required conversion to general anesthesia. After a mean follow-up of 18.2 months, mechanical complications included pericatheter/incision leakage (12.62 %), flow obstruction (4.60 %), incision/exit site hernia (3.45 %), hemoperitoneum (2.30 %), pleuroperitoneal fistula (1.15 %), scrotal leak (1.15 %), and migration (1.15 %). Infectious complications included exit site infection (1 episode per 312.95 patient-months) and peritonitis (1 episode per 31.93 patient-months). Revision-free catheter survival was 97.6 % after 1 year. CONCLUSION Laparoscopic implantation of a PD catheter with N2O pneumoperitoneum and local anesthesia is safe and effective in patients with severe renal failure. N2O is an inert gas and better tolerated as an insufflation agent, enabling awake procedures. Our results show that catheter-related functional outcomes are comparable to those in the existing literature. This approach can be recommended as a good option for catheter implantation in patients needing dialysis.
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Balafa O, Koundouris S, Mitsis M, Siamopoulos KC. An unusual case of hemoperitoneum: spontaneous rectus sheath hematoma. Perit Dial Int 2014; 34:134-5. [PMID: 24525605 DOI: 10.3747/pdi.2012.00178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- O Balafa
- Department of Nephrology1 Department of Surgery2 Internal Medicine3 University of Ioannina Ioannina, Greece
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Guglielmi KE. Women and ESRD: modalities, survival, unique considerations. Adv Chronic Kidney Dis 2013; 20:411-8. [PMID: 23978546 DOI: 10.1053/j.ackd.2013.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 12/27/2022]
Abstract
Women currently constitute 44.3% of prevalent patients on hemodialysis and 47% of those on peritoneal dialysis. Women on dialysis do not experience the survival benefit seen in those not on dialysis. This loss of a survival advantage is partially related to a lower cardiovascular survival benefit along with a higher noncardiovascular mortality rate compared with their male counterparts. Of particular concern is the markedly higher mortality rates seen in women less than 45 years of age on dialysis. There are several female hormonal abnormalities in the female dialysis patient that can result in menstrual irregularities, anovulation, infertility, sexual dysfunction, early menopause, accelerated bone loss, and potentially increased risk of cardiovascular complications. Although fertility is impaired in dialysis, conception occurs in 1% to 7% of women of childbearing years on dialysis. Hence, all women with a potential for pregnancy should be counseled regarding the risks of pregnancy and contraceptive options. There are specific gynecologic considerations unique to peritoneal dialysis, including hemoperitoneum, decreased fertility, and uterine prolapse. Sexual dysfunction is commonly seen in the female dialysis population and is associated with depression and a lower quality of life; however, despite the high prevalence, it is generally not assessed nor is it treated. Depression is also common in the female dialysis population. Like sexual dysfunction, depression is underdiagnosed and undertreated in this population.
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Yaseen O, El Nekidy WS, Ibrahim AR, Jasey BB, Guignard M, Kadri A. Cyclic pseudoperitonitis secondary to endometriosis in a peritoneal dialysis patient. Perit Dial Int 2013; 32:662-4. [PMID: 23212863 DOI: 10.3747/pdi.2012.00099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Steele DJR, Kasmar AG, Guimaraes AR, Dekker JP. Case records of the Massachusetts General Hospital. Case 3-2013. A 72-year-old woman with abdominal pain and distention after peritoneal dialysis. N Engl J Med 2013; 368:375-85. [PMID: 23343067 DOI: 10.1056/nejmcpc1208142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David J R Steele
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, USA
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Fourtounas C, Maroulis I, Karnabatidis D, Hardalias A, Vlachojannis JG. Salvage of a totally occluded peritoneal dialysis catheter by laparoscopic milking. Semin Dial 2012; 26:E8-E10. [PMID: 23013545 DOI: 10.1111/sdi.12006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mechanical problems of the Peritoneal Dialysis (PD) catheter remain a significant cause of temporary or even permanent transfer to hemodialysis. Until recently, the most popular approach was to remove the problematic PD catheter than to try to salvage it. We report a case of severe (two-way) PD catheter obstruction that appeared after spontaneous hemoperitoneum and did not resolve with multiple conservative measures. However, it was successfully salvaged by laparoscopic surgery and milking of a big intraluminal clot.
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Affiliation(s)
- Costas Fourtounas
- Department of Internal Medicine - Nephrology, Patras University Hospital, Patras, Greece.
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Ling EK, Lin BS, Chiang SS, Tsai MH. Cola-colored dialysate as a gastrointestinal sequelae of cardiac surgery in a patient who underwent peritoneal dialysis. Ren Fail 2012; 34:1160-2. [PMID: 22888910 DOI: 10.3109/0886022x.2012.711731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The discoloration of effluent peritoneal dialysate, which is transparent in origin, is seen in some particular conditions including chyloperitoneum, calcium channel blocker usage, hemoperitoneum, perforated cholecystitis, iron administration, and hemorrhagic pancreatitis. We report a case of a 60-year-old woman who underwent peritoneal dialysis for 3 years and presented with conspicuous cola-colored (brownish-black) dialysate after a cardiac surgery. The findings of the dialysate analysis and the abdominal computed tomography showed that this discoloration could be due to the presence of methemalbumin caused by pancreatitis (not hemorrhagic) combined with intra-abdominal bleeding-both of which are rare gastrointestinal complications of cardiac surgery. She eventually died of pulseless electrical activity due to severe sepsis with profound shock. Therefore, the rare event of cola-colored peritoneal dialysate could present as severe gastrointestinal sequelae of cardiac surgery and may indicate a poor prognosis.
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Affiliation(s)
- Eng-Kian Ling
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Tsai HB, Hsu CS, Shiao CC. Hemoperitoneum Due to Tenckhoff Catheter–Caused Luteal Cyst Rupture. Am J Kidney Dis 2011; 58:861. [DOI: 10.1053/j.ajkd.2011.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 08/24/2011] [Indexed: 11/11/2022]
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Yap D, Yip T, Lui S, Lo W. Ruptured Abdominal Aortic Aneurysm as a Cause of Spontaneous Hemoperitoneum in a Patient on Peritoneal Dialysis. Perit Dial Int 2011; 31:600-2. [PMID: 21976477 DOI: 10.3747/pdi.2011.00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- D.Y.H. Yap
- Renal Unit Tung Wah Hospital Hong Kong SAR, PR China
| | - T.P.S. Yip
- Renal Unit Tung Wah Hospital Hong Kong SAR, PR China
| | - S.L. Lui
- Renal Unit Tung Wah Hospital Hong Kong SAR, PR China
| | - W.K. Lo
- Renal Unit Tung Wah Hospital Hong Kong SAR, PR China
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