Abstract
A history of frequent abdominal surgery is generally considered one of the contraindications for CAPD therapy. However, we managed a patient successfully by CAPD, although the patient had megacolon in adulthood, genital anomaly and hypospadias at birth and had frequently undergone abdominal surgeries including ileus. A 41-year-old man who is an office worker had undergone colostomy creation at birth, due to imperforate anus, genital anomaly, and hypospadias. At 5 years old, a newly created anus at the perineum allowed closure of the stoma. Thereafter, he had frequently undergone abdominal surgery including ileus till the middle grade of elementary school. Thereafter, he received no further medical treatment until adulthood. He had megacolon, urinary and fecal incontinence in later adulthood and used disposable diapers. In 1994, he underwent resection of the left kidney because of ureteral calculus. From 2003, uropathy caused chronic renal failure. In May 2006, he started hemodialysis therapy. However he had some difficulties with AV-shunt and preferred CAPD therapy. At catheter insertion, we performed a median incision at the upper abdomen under general anesthesia, and then observed the peritoneum using an endoscope. We placed an indwelling catheter into his abdomen using the presternal catheter method after we ascertained an adequate capacity of right abdominal cavity from the pelvis, outside the surgical scar, to the right hypogastric area. After the start of CAPD therapy, sufficient clearance was achieved with residual renal function. At present, he has not demonstrated any complications or problems with CAPD. We consider that CAPD is feasible and should not be excluded in patients with megacolon or a past history of frequent abdominal surgery including ileus.
