Double hernia in continuous ambulatory peritoneal dialysis patient

Excerpt

A 42-year-old woman receiving continuous ambulatory peritoneal dialysis (CAPD) was presented to the emergency department, complaining of abdominal pain that persisted over 6 h. She has been maintained on CAPD due to end-stage renal disease since about 2 years ago. She did not experience any event which associated with CAPD-related technical problems, including CAPD peritonitis. Since she started peritoneal dialysis, she has not had hernias, or any symptoms related to hernias. Her vital signs were stable. On physical examination of abdomen, wide bulging of abdominal wall that involves periumbilical area and dialysis catheter exit site was observed. Definitive tenderness at this lesion was not observed. We checked abdominal computed tomography (CT) to identify what the lesion was. At axial view of abdominal CT, mesenteric fat and bowel protrude through the abdominal wall at the umbilicus (Fig. 1a). In addition, herniation of preperitoneal fat tissue through the defect of peritoneal catheter insertion site was observed simultaneously (Fig. 1b). Finally, she was diagnosed as a double hernia with simultaneous umbilical hernia and incisional hernia. Since there was no evidence of strangulation, she was discharged after a successful manual reduction. The reason for her sudden hernia was unknown. The peritoneal dialysis was maintained well without any major problems before the visit, and no event that could increase the intra-abdominal pressure was recorded. However, after that, hernia recurred repeatedly, and she underwent mesh repair. The CAPD catheter was then removed and converted to hemodialysis.

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