R Ling1, M Lanteri1
1St Vincent’s Hospital Melbourne, Fitzroy, Australia
Background: Intraabdominal adhesions are commonly a consequence of surgical injury to peritoneal surfaces. An imbalance between the inflammatory reaction from an insult and healing response results in more fibrin deposition than fibrinolysis. Ischaemia, blood, foreign bodies, bacteria and drugs also impair fibrinolysis. Coronavirus disease 2019 (COVID-19) may be driven by systemic inflammation rather than direct viral injury, associated with raised inflammatory markers.
Although often subclinical, symptomatic adhesions cause intestinal obstruction, chronic pain and infertility in women. Inadequate peritoneal dialysis can occur if the catheter is trapped in a loculated compartment. This case of abdominal adhesions prevented successful peritoneal dialysis, in a pre-dialysis patient who had COVID-19.
Case Report: A 55-year-old male with chronic renal impairment (related to longstanding diabetes, obesity, hypertension, and previous smoking) was admitted to intensive care with respiratory and acute-on-chronic renal failure due to COVID-19. He did not complain of gastrointestinal symptoms. Serum creatinine had been stable for several years (344mcmol/L), but on admission he required acute haemofiltration and ventilation. After the acute illness resolved, serum creatinine settled at a new baseline (549mcmol/L), but gradually rose to 1,121 over the next five months with no specific cause identifiable (renal biopsy was not performed). Due to symptomatic uraemia, renal replacement therapy was initiated.
During laparoscopic insertion of a peritoneal dialysis catheter, abdominal adhesions were visualised. Peritoneal exchanges were unsuccessful; haemodialysis was instituted.
Conclusions: This case demonstrates an unexpected finding of adhesions in a patient with a virgin abdomen. The most likely cause is recent COVID infection. Further research into this association may have clinical implications on preferred dialysis modalities in pre-dialysis patients who have had COVID.
Rebecca Ling is a second-year nephrology advanced trainee currently working at St. Vincent’s Hospital Melbourne, Victoria. She is passionate about research that is translatable to clinical practice.