Perforation of the small intestine incarcerated within the deformed pelvic cavity by hip arthroplasty in a CAPD patient

Abstract

We report a 46-year-old female patient on continuous ambulatory peritoneal dialysis(CAPD) who experienced perforation of the ileum incarcerated within the deformed pelvic cavity behind the metal bolt of the implanted head of the right femur. The patient had undergone right hemi-pelvectomy accompanied by total hip arthroplasty for alveolar soft-tissue sarcoma at the age of 41. She was also being treated by CAPD as therapy for end-stage renal disease resulting from hypertensive nephrosclerosis since 2007. In March 2008, she underwent surgery for femur neck fracture and the metal bolt was implanted. She developed abdominal pain in May 2008, which became aggravated and showed turbid CAPD fluid. She was admitted to our hospital because of peritonitis. Six-day administration of antibiotics resulted in no improvement, and her symptoms became further aggravated demonstrating and an increased cell count in cloudy brown-yellow CAPD fluid. Three species of bacilli were detected in the CAPD fluid and imipenem/cilastatin sodium(IPM/CS) was administered. As there was no improvement, we performed abdominal computed tomography and detected a free air space within the abdominal cavity. Emergency surgery demonstrated that the head of the metal bolt was palpable in the pelvic cavity and the small intestine was incarcerated behind it within the deformed pelvic cavity due to partial pelvectomy. Furthermore, there was a perforation at the terminal ileum. Partial ileectomy was performed and the postoperative course was uneventful. Her dialysis therapy was switched to hemodialysis. Perforation of the small intestine incarcerated within the deformed pelvic cavity following hip arthroplasty in a CAPD patient has not been reported previously. A procedure that deforms pelvic cavity may precipitate incarceration leading to complicated peritonitis, which should be differentiated from simple peritonitis.