Acute appendicitis and secondary peritonitis in a patient with end-stage renal failure and a dormant peritoneal dialysis catheter
DOI:
https://doi.org/10.18203/2349-2902.isj20250148Keywords:
Peritoneal dialysis, End-stage renal disease, Peritonitis, Perforated appendicitis, Dormant PD catheter, Laparoscopic appendectomyAbstract
Peritoneal dialysis (PD) is a common renal replacement therapy for patients with end-stage renal disease (ESRD). Despite its benefits, PD-related peritonitis remains a severe complication, often associated with significant morbidity and mortality. Although most cases of PD-related peritonitis are due to touch contamination, intra-abdominal infections, such as appendicitis, are less common but can result in severe outcomes. We present a case of severe peritonitis secondary to perforated appendicitis in a patient with a dormant PD catheter. A 41-year-old male with ESRD, previously on PD, presented with a 36-hour history of fever, chills, nausea, and abdominal pain. Despite transitioning to hemodialysis, the patient had retained his PD catheter, which had not been used for months. On admission, the patient was septic with evidence of peritonitis. Blood cultures were positive for Escherichia coli, while PD catheter cultures were negative. An abdominal CT scan revealed a gangrenous perforated appendix. The patient underwent an emergency laparoscopic appendectomy and PD catheter removal, resulting in significant clinical improvement. Perforated appendicitis in ESRD patients with a PD catheter can result in severe peritonitis with life-threatening complications, including sepsis and cardiac events. This case underscores the importance of maintaining a high index of suspicion for intra-abdominal causes of peritonitis in PD patients, even when the PD catheter is dormant. Timely diagnosis, empiric antibiotic therapy, and prompt surgical management are essential to reduce mortality in these patients.
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Salzer WL. Peritoneal dialysis-related peritonitis: challenges and solutions. Int J Nephrol Renovas Dis. 2018;2:173-86. DOI: https://doi.org/10.2147/IJNRD.S123618
Najafi I, Alatab S, Atabak S, Majelan NN, Sanadgol H, Makhdoomi K, et al. Seventeen years’ experience of peritoneal dialysis in Iran: first official report of the Iranian peritoneal dialysis registry. Perit Dial Int. 2014;34(6):636-42. DOI: https://doi.org/10.3747/pdi.2012.00054
Perl J, Fuller DS, Bieber BA, Boudville N, Kanjanabuch T, Ito Y, et al. Peritoneal dialysis–related infection rates and outcomes: results from the peritoneal dialysis outcomes and practice patterns study (PDOPPS). Am J Kidney Dis. 2020;76(1):42-53. DOI: https://doi.org/10.1053/j.ajkd.2019.09.016
Lee YC, Hung SY, Wang HH, Wang HK, Lin CW, Chang MY, et al. Different risk of common gastrointestinal disease between groups undergoing hemodialysis or peritoneal dialysis or with non-end stage renal disease: a nationwide population-based cohort study. Med. 2015;94(36):1482. DOI: https://doi.org/10.1097/MD.0000000000001482
Ekart R, Horvat M, Koželj M, Balon BP, Bevc S, Hojs R. Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report. J Med Case Rep. 2012;6:1-4. DOI: https://doi.org/10.1186/1752-1947-6-309
Nwanji V, Burkholder G, Kaur G. A case report of malfunctioning peritoneal dialysis catheter in a patient with diverticulitis with a phlegmon. Cureus. 202;13(4):34-9.
Thom T, Leonard D, Fitzpatrick P, Aslam N. Transection versus infection: acute appendicitis in a peritoneal dialysis patient presenting as catheter dysfunction and discontinuity on X-ray. Case Reports. 2018;6:17-8. DOI: https://doi.org/10.1136/bcr-2017-223863
Gupta R, Woo K, Yi JA. Epidemiology of end-stage kidney disease. Seminars in Vascular Surg. 2021;34(1):71–8. DOI: https://doi.org/10.1053/j.semvascsurg.2021.02.010
Sachdeva B, Zulfiqar H, Aeddula NR. Peritoneal Dialysis. 2023. Available at: www.ncbi.nlm.nih.gov. Accessed on 12 August 2024.
Al Sahlawi M, Bargman JM, Perl J. Peritoneal dialysis–associated peritonitis: suggestions for management and mistakes to avoid. Kidney Medicine. 2020;2(4):467-75. DOI: https://doi.org/10.1016/j.xkme.2020.04.010
Takezawa Y, Saitou Y, Uchida T, Hirahara I, Kusano E, Kobayashi M. Matrix metalloproteinase levels in peritoneal effluents were increased in a patient with appendicitis undergoing continuous ambulatory peritoneal dialysis. Clin and Experimen Nephrol. 2012;16:501-4. DOI: https://doi.org/10.1007/s10157-011-0576-0
Grupp A, Kimmel M, Fritz P, Voggenreiter B, Stöltzing H, Kuhlmann U, et al. The expression patterns of peritoneal defensins. Peritoneal dialysis Int. 2007;27(6):654-62. DOI: https://doi.org/10.1177/089686080702700611
Braun N, Fritz P, Ulmer C, Latus J, Kimmel M, Biegger D, Ott G, Reimold F, Thon KP, Dippon J, Segerer S. Histological criteria for encapsulating peritoneal sclerosis–a standardized approach. PLoS One. 2012;7(11):48647. DOI: https://doi.org/10.1371/journal.pone.0048647
Anwar N, Chawla LS, Lew SQ. Emphysematous pyelitis presenting as an acute abdomen in an end-stage renal disease patient treated with peritoneal dialysis. Am J Kid Dis. 2002;40(4):13-5. DOI: https://doi.org/10.1053/ajkd.2002.35703
Akoh JA. Peritoneal dialysis associated infections: an update on diagnosis and management. World J Nephrol. 2012;1(4):106. DOI: https://doi.org/10.5527/wjn.v1.i4.106
Mizuno M, Suzuki Y, Nonaka K, Sei Y, Maruyama S, Matsuo S, et al. Perforative peritonitis caused by appendicitis in a patient on peritoneal dialysis. Internal Med. 2013;52(11):1177-81. DOI: https://doi.org/10.2169/internalmedicine.52.9196
Carmeci C, Muldowney W, Mazbar SA, Bloom R. Emergency laparotomy in patients on continuous ambulatory peritoneal dialysis. The American Surg. 2001;67(7):615–8. DOI: https://doi.org/10.1177/000313480106700702
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