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Osaki Y, Maeoka Y, Sami M, Takahashi A, Ishiuchi N, Sasaki K, Masaki T. Peritoneal dialysis-associated peritonitis, caused by superior mesenteric artery thrombosis with intestinal necrosis: a case report. CEN Case Rep 2024:10.1007/s13730-024-00894-y. [PMID: 38825653 DOI: 10.1007/s13730-024-00894-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/14/2024] [Indexed: 06/04/2024] Open
Abstract
Peritoneal dialysis (PD)-associated peritonitis is a common complication of PD. Enteric peritonitis is defined as peritonitis arising from an intestinal or intra-abdominal organ source. The delay in the diagnosis or treatment of enteric peritonitis has been reported to increase mortality. Therefore, the early consideration of enteric peritonitis, particularly in cases of culture-negative peritonitis, is imperative. A 67-year-old Japanese man who had been undergoing PD for 3 years, was admitted to our hospital with a diagnosis of PD-associated peritonitis. A month previously, he experienced a bleeding gastric ulcer, which led to severe anemia (hemoglobin 6.3 mg/dL), followed by thrombocytosis. On admission, peritoneal fluid analysis showed a high white blood cell count (WBC: 8,570 /µL), with neutrophils predominating (74.5%). Cultures of both his dialysis effluent and blood were negative. After admission, the WBC count of the dialysis effluent gradually decreased alongside antibiotic therapy, but the patient's abdominal pain did not improve. After 4 days, enhanced computed tomography showed superior mesenteric artery (SMA) thrombosis and intestinal necrosis. Therefore, emergency intestinal resection and PD catheter removal were performed, and then antithrombosis therapy was initiated. Because the patient's abdominal pain was improved and platelet count and D-dimer concentration were reduced by these treatments, he was discharged from the hospital after 47 days. Thus, we report a rare case of culture-negative PD-associated peritonitis, which was caused by SMA thrombosis and intestinal necrosis. It is likely that combination of severe calcification of SMA and prolonged thrombocytosis secondary to the severe anemia contributed to the thrombosis.
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Affiliation(s)
- Yosuke Osaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yujiro Maeoka
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Mai Sami
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Akira Takahashi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Naoki Ishiuchi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Kensuke Sasaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
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Khaldy M, Arafat H, Samoudi A, Shawamreh B. Appendicitis Misdiagnosed as Peritoneal Dialysis-Related Peritonitis: A Case Report. Cureus 2023; 15:e43616. [PMID: 37719503 PMCID: PMC10504571 DOI: 10.7759/cureus.43616] [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: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Abdominal pain in patients on continuous ambulatory peritoneal dialysis (PD) is considered a serious, alarming symptom since they are at increased risk for exogenous infection introduced through the peritoneal catheter. Differential diagnosis includes perforated peptic ulcer, cholecystitis, ischemic colitis, appendicitis, diverticulitis, ingestion of foreign body, or malignancy. Typical features of perforation include signs of acute abdomen in addition to free air under the diaphragm detected on imaging. Perforation is an indication of emergency laparotomy, which is the gold standard for diagnosis. We reported a case of a 23-year-old Palestinian male patient who had recently started continuous ambulatory PD. He presented with generalized, colicky abdominal pain associated with nausea and vomiting. He noticed turbid peritoneal fluid while performing daily dialysis sessions. The patient was diagnosed with PD-related peritonitis but had no improvement on intraperitoneal antibiotics. Further evaluation revealed an intraabdominal cause, a perforated appendix. He underwent an urgent laparotomy and switched to hemodialysis. The patient expired due to the complications of his disease. Although PD-related peritonitis is readily diagnosed in patients on continuous ambulatory PD, an underlying intraabdominal pathology should be suspected when the condition is resistant to conventional treatment. Accepting or refuting such a diagnosis can be challenging.
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Affiliation(s)
- Marah Khaldy
- Department of Internal Medicine, Augusta Victoria Hospital, Jerusalem, PSE
| | - Hasan Arafat
- Department of Internal Medicine, Augusta Victoria Hospital, Jerusalem, PSE
| | - Aseel Samoudi
- Department of Internal Medicine, Augusta Victoria Hospital, Jerusalem, PSE
| | - Belal Shawamreh
- Department of Internal Medicine, Augusta Victoria Hospital, Jerusalem, PSE
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Thom T, Leonard D, Fitzpatrick P, Aslam N. Transection versus infection: acute appendicitis in a peritoneal dialysis patient presenting as catheter dysfunction and discontinuity on X-ray. BMJ Case Rep 2018; 2018:bcr-2017-223863. [PMID: 29666088 DOI: 10.1136/bcr-2017-223863] [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: 11/04/2022] Open
Abstract
Acute appendicitis in peritoneal dialysis patients generally presents as abdominal pain and cloudy dialysate. We report a case of acute appendicitis in a peritoneal dialysis patient that presented as poor dialysate fluid drainage and an abnormal abdominal X-ray showing breakage in the continuity of the catheter. Catheter dysfunction in this case was caused by acute appendicitis leading to the formation of adhesions with peritoneal dialysis catheter trapped in it. This resulted in radiological appearance of catheter breakage, although catheter itself was intact. Clinicians should be aware of this rare presentation of acute appendicitis-poor drain alarm and radiological appearance of catheter discontinuity.
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Affiliation(s)
- Tatiana Thom
- Divison of Nephrology and Hypertension, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - Deanne Leonard
- Divison of Nephrology and Hypertension, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - Peter Fitzpatrick
- Divison of Nephrology and Hypertension, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - Nabeel Aslam
- Divison of Nephrology and Hypertension, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
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