A plain X-ray in peritoneal dialysis-related peritonitis

Excerpt

A 47-year-old man on Continuous Ambulatory Peritoneal Dialysis (CAPD) presented in septic shock with abdominal pain, fever, drowsiness and cloudy effluent through the peritoneal dialysis (PD) catheter. A plain X-Ray (Fig. 1) of the abdomen showed typical features of an extra-peritoneal collection with an air-fluid level. An urgent bedside ultrasonography (USG) of the abdomen was done which confirmed the presence of a large walled-off collection behind the anterior abdominal wall. Two pigtail catheters were inserted into the collection from either side under ultrasound guidance. Following the drainage of the collection, he improved markedly. A subsequent Computed Tomography (CT) of the abdomen confirmed the residual collection (Fig. 2). The cultures grew Enterobacter and Candida. Meropenem and Amphotericin B (AmB) were administered for 6 weeks. The pigtail catheters were removed after serial follow-up imaging revealed no residual collection and the patient is now stable and has been transferred to hemodialysis.

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