Abstract
Catheter malfunction is one of the most common complications of peritoneal dialysis, and it can result from catheter migration, fibrin deposition, omental wrapping, or occlusion due to other different intraperitoneal organs. The obstruction of a peritoneal dialysis catheter by the fimbria of the fallopian tube is an unusual complication. We report a successful case of laparoscopic salvage of peritoneal dialysis catheter obstruction caused by the fimbria of the fallopian tube. In July 2011, a 76-year-old woman with chronic renal failure due to nephrosclerosis had a peritoneal dialysis catheter placed through a right paramedian transrectal incision. On July 25, continuous ambulatory peritoneal dialysis (CAPD) was started without difficulty. She began automated peritoneal dialysis (APD) on the fourth day without difficulty, but, on the fifth day, in-flow disability triggered an alarm. After that, she developed in- and out-flow problems. The injection of a water-soluble contrast agent into the peritoneal dialysis catheter radiographically demonstrated filling defects (called an “octopus sign”) which are occlusion of the side holes and partial lumen obstruction. On August 29, diagnostic laparoscopy was performed. The peritoneal dialysis catheter was found to be enveloped by the right fimbria of the fallopian tube. The fimbria of the fallopian tube appeared to have entered the side holes and lodged in the lumen of the catheter. The fimbria of the fallopian tube were carefully removed, and the fallopian tube was sutured to the parietal peritoneum in the hope of preventing recurrence. Two hundred milliliters of heparinized saline were instilled in the abdominal cavity through the catheter. Eight days later, CAPD was restarted without difficulty.
