D O’HARA1, K MURALI1, M WAYNE1
1Wollongong Hospital Renal Department, Wollongong, Australia
Background: Peritoneal loose bodies (PLB) or “peritoneal mice” are typically caused by fat necrosis of epiploic appendages with resultant auto-amputation and subsequent calcification. The rate of incidence is unknown and the condition usually causes few or non-specific symptoms. In patients undergoing peritoneal dialysis (PD), PLB have the potential to cause PD catheter outflow obstruction, but no such cases have been reported.
Case Report: A 70-year old male with end-stage kidney disease due to hypertensive nephrosclerosis commenced PD one year before the index presentation. He had no prior abdominal surgeries and never had PD peritonitis. He noticed intermittent PD catheter outflow obstruction over two weeks with preserved inflow. He experienced two episodes of total inability to drain PD fluid with resultant fluid absorption. He had daily bowel movements on aperients. An abdominal x-ray excluded constipation and catheter malposition. An alteplase lock was used, in hope of dislodging a presumed fibrin clot, but the catheter outflow didn’t improve. He was suspected to have omental wrapping of the PD catheter and a decision was made to proceed with surgical exploration for possible omentectomy and catheter replacement. When planning for surgery he was noted to have a flesh-coloured material sliding in the PD catheter lumen, which was carefully milked out. Histopathology revealed heavily calcified material with organising fat necrosis. After the material was squeezed out, the PD catheter function was perfectly restored with no further issues.
Conclusions: We report a case of PD catheter outflow obstruction caused by peritoneal loose body due to calcified organising fat necrosis. Awareness of this entity could prompt the clinician to recognise the condition, which may help to streamline management and avoid unnecessary surgery.
Dr Daniel O’Hara is a second-year renal Advanced Trainee in the East Coast Renal Network. He has a keen interest in general nephrology, dialysis, obstetric medicine and global renal health.