Case of peritoneal dialysis withdrawal within one year due to peritonitis associated with severe enteritis

Abstract

A 59‒year‒old man started peritoneal dialysis (PD) one year prior to consultation. He presented with a 4‒day history of abdominal pain, diarrhea, and cloudy peritoneal effluent. Physical examination revealed signs of peritoneal irritation, and analysis of the PD effluent revealed cloudiness and an elevated cell count, leading to a diagnosis of PD‒related peritonitis. Intravenous antibiotics and peritoneal lavage fluid were administered. Cultures of CAPD effluent collected at the time of admission were positive for multiple organisms； however, as there were no findings suggestive of intestinal perforation, conservative treatment was continued. From hospital day 3, poor effluent drainage was observed, but this was attributed to intestinal edema associated with enteritis, and conservative observation was continued. Although the diarrhea improved, the outflow dysfunction persisted. On hospital day 21, abdominal CT suggested encapsulated ascites, and diagnostic laparoscopy was performed. Intraoperatively, severe intra‒abdominal adhesions were observed, and the PD catheter was encased in fibrous tissue. Adhesiolysis was conducted and the catheter was removed. He was switched to hemodialysis and discharged on hospital day 47. This case was considered to involve catheter encapsulation due to inflammation caused by secondary PD‒related peritonitis triggered by enteritis. Severe inflammation can lead to intra‒abdominal adhesions and necessitate withdrawal from PD, even in patients with a short history of PD and first‒time peritonitis.