Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
CASE REPORTS
Perforative Peritonitis caused by Appendicitis in a Patient on Peritoneal Dialysis
Masashi MizunoYasuhiro SuzukiKeisuke NonakaYumi SeiShoichi MaruyamaSeiichi MatsuoYasuhiko Ito
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JOURNALS OPEN ACCESS

2013 Volume 52 Issue 11 Pages 1177-1181

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Abstract

A 46-year-old man on peritoneal dialysis (PD) was hospitalized due to suspicious PD-related peritonitis. Because the patient's abdominal pain was unimproved by conventional antibiotics and multiple bacteria were identified in a smear-sample of PD fluid, endogenous peritonitis was suspected. Perforated appendicitis was finally diagnosed under exploratory laparotomy. In this patient, perforated appendicitis was difficult to diagnose due to the attenuated clinical symptoms and inconclusive results of abdominal computed tomography (CT), even though the positive predictive value of CT is >95% in non-PD patients. Quickly deciding to perform exploratory laparotomy in patients suspected of having endogenous peritonitis is thus important, even when the origin has not been clarified.

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© 2013 by The Japanese Society of Internal Medicine
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