Late peritoneal leakage

Excerpt

A 68-year-old uremic female on continuous ambulatory peritoneal dialysis (CAPD) for 8 years developed progressive lower abdominal and genital edema together with reduced dialysate effluent volumes for 1 week. She underwent laparoscopic placement of a CAPD catheter with fixation to maintain catheter position 8 years ago. On examination, she had a weight gain of 3 kg and symmetric edema of the lower abdomen and genitalia. Her peritoneal membrane transport remained unchanged (high average). Abdominal plain film showed no catheter migration. Despite an increasing dose of hypertonic exchanges, there was no improvement in her symptoms. Computed tomography (CT) peritoneography using 100 mL iopromide (300 mgI/mL) added to 2 L dialysate showed peritoneal leakage 7 cm caudally to the umbilicus with contrast medium accumulation in the lower abdominal wall (Fig. 1). Surgical exploration revealed an opening of the peritoneum with fluid leakage at the previous catheter fixation site that was treated with fibrin sealant and mesh repair. She was switched to hemodialysis for 2 weeks and restarted CAPD without recurrent leakage afterwards.

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