1John Hunter Hospital, Newcastle, New South Wales
Background: Peritoneal dialysis (PD) continues to remain a viable dialysis modality with at least 60-90% of home-based patients performing PD across Australia. PD allows patients to maintain greater independence and a more normal lifestyle to participate in usual activities of daily living. Complications of peritonitis, catheter migration and exit site infections are not uncommon and often lead to membrane failure.
Case Report: A 49 year-old lady on peritoneal dialysis presented to hospital with diffuse abdominal pain, fevers and cloudy dialysate. Her underlying renal disease was diabetic nephropathy and the peritoneal dialysis catheter had been laparoscopically inserted 6 months prior to this presentation. Dialysis had been complicated by an episode of uncomplicated Staphylococcus epidermidis peritonitis and a pleural leak. Initial treatment in hospital began with empiric intra-peritoneal antibiotics after a PD fluid sample demonstrated a white cell count of 213 x 106 (98% neutrophils) with growth of mixed anaerobes on fluid culture which was concerning for secondary peritonitis. Upon performing directly observed manual exchanges the patient had instantaneous faecal incontinence of clear fluid and dipstick analysis of this fluid was positive for glucose suggestive of dialysate solution. A contrast-enhanced CT of the abdomen revealed penetration of the PD catheter into the rectosigmoid colon and a likely colovesical fistula. Prompt laparoscopic catheter removal was performed via a suprapubic incision whereby the catheter was noted to be covered in faecal material. The patient recovered uneventfully after catheter removal but required change in dialysis modality.
Conclusions: Despite the ongoing utility of peritoneal dialysis migration of the PD catheter can occur which can rarely cause intra-abdominal viscus penetration and fistula formation.