First episode of severe refractory peritonitis after 10 years of peritoneal dialysis

Abstract

Peritoneal dialysis (PD)‒related peritonitis is a serious complication that can cause PD withdrawal and be fatal. An 80‒year‒old woman started PD 10 years ago due to end‒stage renal failure caused by nephrosclerosis. She was converted to PD and hemodialysis (HD) 9 years ago and continued without PD‒related complications. At the age of 80 years, she was admitted with a diagnosis of PD‒related peritonitis for the first time. Antibiotics were started on the first day, and the patient’s condition resolved temporarily. However, Serratia marcescens was detected on PD drainage culture. On the 7th day, abdominal pain flared up and persisted even after antimicrobial therapy. On the 10th day, simple computed tomography of the abdomen showed encapsulated ascites with air bubbles, and emergency laparotomy was performed on the same day. The small intestine showed thickening of the wall and adhesions due to inflammation. Postoperatively, fever resolved, abdominal pain disappeared, and she was transferred to receive HD alone. Currently, she is doing well under outpatient follow‒up. PD‒related peritonitis caused by Serratia marcescens is a serious disease, and PD‒related peritonitis itself could lead to the development of encapsulating peritoneal sclerosis with neutral‒pH peritoneal dialysate. Therefore, it is important to be aware that PD‒related peritonitis can worsen rapidly after the initial onset of the disease.