FAECULENT CATHETER DRAINAGE – AN UNUSUAL COMPLICATION OF PERITONEAL DIALYSIS ACCESS
Zena Barakat1, Rajesh Raj1, Mathew C Mathew 1, Duncan Cooke1 1Launceston General Hospital, Launceston, TAS, Australia
Abstract
Background:
Peritoneal dialysis (PD) is an effective form of dialysis, and a well-functioning PD catheter is critical for successful treatment. Several well-recognized complications of PD catheters include infections, mechanical issues, and intra-abdominal visceral injury (including bowel erosion and perforation). Previous reports of small bowel erosion from PD catheters have been in symptomatic patients presenting with sepsis, pain, or diarrhoea at dialysate instillation.
Case Report:
We present a case of a 77-year-old man with end-stage kidney disease who had an uneventful laparoscopic insertion of a PD catheter in preparation for commencing dialysis. Initially, he experienced intermittent difficulties draining and filling dialysate, delaying dialysis initiation. Several weeks later, the patient noticed the PD catheter draining thick, brown fluid with brown debris and gas. The fluid culture identified a polymicrobial growth, consistent with bowel flora. CT of the abdomen revealed that the intra-abdominal part of the PD catheter was positioned inside the distal small bowel loop. Despite this, no indications of bowel perforation or erosion were observed, including abdominal pain or sepsis. Further imaging with a CT-tubogram confirmed that the catheter was in the small bowel, without contrast leakage into the peritoneum. Consequently, the catheter was removed, alongside partial resection of the small bowel, and he made an uneventful recovery.
Conclusion:
We report a unique instance of small bowel erosion from a PD catheter in an asymptomatic patient who had not yet commenced dialysis. This case underscores the crucial role of radiographic procedures in confirming the location of the catheter tip in patients with unusual material in their PD catheter. Furthermore, this case adds to the catalogue of presentations and complications associated with PD catheters.
Biography
Zena Barakat is a first year advanced trainee in Nephrology at Launceston General Hospital in Tasmania. She is currently completing a higher degree by research at the University of Melbourne exploring the epidemiology and outcomes after kidney injury using data linkage.