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Intestinal fistula accompanied by recurrent peritonitis associated with peritoneal dialysis: a case report.

ABSTRACT: BACKGROUND:Intestinal perforation from peritoneal dialysis is rare, but the resulting complications are serious. Some patients do not necessarily have symptoms, and it can be difficult to differentiate their condition from PD-related (peritoneal dialysis-related) peritonitis, which may lead to misdiagnosis. Here we report a peritoneal dialysis patient with intestinal fistula associated with recurrent peritonitis. CASE PRESENTATION:A 44-year-old man had been treated for more than 6 years with peritoneal dialysis for chronic kidney disease stage-V. Abdominal computed tomography and electronic colonoscopy revealed an appendiceal fossa with adjacent fistula. The peritoneal dialysis catheter was removed, and the patient recovered with no recurrence of complications. CONCLUSION:We report a case of a rare complication of peritoneal dialysis. The intestinal fistula in this patient was mainly caused by recurrent peritonitis and removal of the catheter could control the peritonitis.

SUBMITTER: Shao Q

PROVIDER: S-EPMC7245831 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Intestinal fistula accompanied by recurrent peritonitis associated with peritoneal dialysis: a case report.

Shao Qiuyuan Q Xia Yangyang Y Zhang Qingyan Q Zhang Miao M

BMC gastroenterology 20200524 1

<h4>Background</h4>Intestinal perforation from peritoneal dialysis is rare, but the resulting complications are serious. Some patients do not necessarily have symptoms, and it can be difficult to differentiate their condition from PD-related (peritoneal dialysis-related) peritonitis, which may lead to misdiagnosis. Here we report a peritoneal dialysis patient with intestinal fistula associated with recurrent peritonitis.<h4>Case presentation</h4>A 44-year-old man had been treated for more than 6 ...[more]

PMID: 32448191

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Project description:INTRODUCTION: Continuous ambulatory peritoneal dialysis (CAPD) peritonitis may develop after endoscopic procedures, and the benefit of prophylactic antibiotics is unclear. In the present study, we investigated whether prophylactic antibiotics reduce the incidence of peritonitis in these patients. PATIENTS AND METHODS: We retrospectively reviewed all endoscopic procedures, including esophagogastroduodenoscopy (EGD), colonoscopy, sigmoidoscopy, cystoscopy, hysteroscopy, and hysteroscopy-assisted intrauterine device (IUD) implantation/removal, performed in CAPD patients at Chang Gung Memorial Hospital, Taiwan, between February 2001 and February 2012. RESULTS: Four hundred and thirty-three patients were enrolled, and 125 endoscopies were performed in 45 patients. Eight (6.4%) peritonitis episodes developed after the examination. Antibiotics were used in 26 procedures, and none of the patients had peritonitis (0% vs. 8.1% without antibiotic use; p=0.20). The peritonitis rate was significantly higher in the non-EGD group than in the EGD group (15.9% [7/44] vs. 1.2% [1/81]; p<0.005). Antibiotic use prior to non-EGD examinations significantly reduced the endoscopy-associated peritonitis rate compared to that without antibiotic use (0% [0/16] vs. 25% [7/28]; p<0.05). Peritonitis only occurred if invasive procedures were performed, such as biopsy, polypectomy, or IUD implantation, (noninvasive procedures, 0% [0/20] vs. invasive procedures, 30.4% [7/23]; p<0.05). No peritonitis was noted if antibiotics were used prior to examination with invasive procedures (0% [0/10] vs. 53.8% [7/13] without antibiotic use; p<0.05). Although not statistically significant, antibiotics may play a role in preventing gynecologic procedure-related peritonitis (antibiotics, 0% [0/4] vs. no antibiotics, 55.6% [5/9]; p=0.10). CONCLUSION: Antibiotic prophylaxis significantly reduced endoscopy-associated PD peritonitis in the non-EGD group. Endoscopically assisted invasive procedures, such as biopsy, polypectomy, IUD implantation/removal, and dilatation and curettage (D&C), pose a high risk for peritonitis. Prophylactic antibiotics for peritonitis prevention may be required in colonoscopic procedures and gynecologic procedures.

Project description:BACKGROUND AND OBJECTIVES:Residual kidney function contributes to the clearance of antibiotics excreted by the kidneys, lowering the antibiotic concentration, which may adversely affect the treatment of peritoneal dialysis-associated peritonitis. The objective of our study was to examine the relationship between residual kidneyfunction and peritonitis treatment outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:Our study included 181 participants who experienced 339 episodes of Gram-positive, Gram-negative, and culture-negative peritoneal dialysis-associated peritonitis at a single centerfrom 2003 to 2010. Episodes were categorized according to participants' urinary creatinine clearance (0, >0-5, and >5 ml/min). The data were analyzed using generalized estimating equation models to determine the covariate-adjusted association between urinary creatinine clearance and treatment failure (defined as relapse or recurrent peritonitis episodes, peritoneal catheter removal, or death from any cause during peritonitis treatment). RESULTS:Among episodes of peritonitis due to Gram-positive organisms or culture-negative infections, those experienced by participants with urinary creatinine clearance >5 ml/min had significantly higher odds of treatment failure than episodes experienced by anuric participants (27 of 80 versus 20 of 119 episodes resulting in treatment failure for creatinine clearance >5 versus 0 ml/min; odds ratio, 6.80; 95% confidence interval, 2.37 to 19.6). Episodes experienced by participants with creatinine clearance >0-5 ml/min also had significantly higher odds of treatment failure than episodes experienced by anuric participants (14 of 64 episodes resulting in treatment failure for creatinine clearance >0-5 ml/min; odds ratio, 2.87; 95% confidence interval, 1.12 to 7.35). The odds of relapse and recurrent peritonitis among participants with creatinine clearance >5 ml/min was also significantly higher compared with in anuric participants (17 of 80 versus 12 of 119 episodes resulting in relapse and recurrence for creatinine clearance >5 versus 0 ml/min; odds ratio, 6.76; 95% confidence interval, 1.90 to 23.8). Among participants with Gram-negative peritonitis, creatinine clearance was significantly associated with neither treatment failure nor relapse and recurrent peritonitis. CONCLUSIONS:Residual kidney function as measured by greater urinary creatinine clearance was associated with treatment failure among participants with Gram-positive and culture-negative peritonitis.

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Intestinal fistula accompanied by recurrent peritonitis associated with peritoneal dialysis: a case report.

Publications

Intestinal fistula accompanied by recurrent peritonitis associated with peritoneal dialysis: a case report.

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