Perforated-peritonitis in 4 patients on continuous ambulatory peritoneal dialysis (CAPD)

Abstract

We studied perforated-peritonitis in 4 patients (1 male, 3 females) on CAPD and surveyed the risk factors of and signs useful for diagnosing perforated-peritonitis. The original diseases underlying chronic renal failure differed among the 4 patients. CAPD duration and age also varied among patients. The initial symptoms of perforated-peritonitis were abdominal pain, fever and diarrhea. Specific symptoms of perforated-peritonitis were not recognized in these patients. The presence of free air under the diaphragma was found in 2 patients on abdominal scout films and multiple organisms, identified as anaerobes in culture of the CAPD effluent, were positive in 3 patients. These two signs, i.e. free air and multiple organisms in culture, are considered to be useful for diagnosing perforated-peritonitis.
Decreases in total protein, albumin and cholinesterase in sera were observed before the occurrence of perforated-peritonitis in all four patients.
Our study indicates that malnutrition may be a major factor pre-disposing CAPD patients to bowel perforation.