We investigated 10 cases of perforated peritonitis underlying chronic renal failure (CRF) which were managed by chronic dialysis, in order to clarify their clinical characteristics. In fifty per cent of the cases, the etiology of peritonitis was a colonic perforation. The average time from onset to consultation was approximately 73 hours, and it was suggested that this delay may have contributed to the severe general condition at admission. There were 2 cases with leucocytopenia, which were treated by injection of G-CSF. We found 4 patients with DIC before surgery, so it was important that nafamostat mesilate and AT-III were injected perioperatively to prevent bleeding complications. The positive rate of bacteria in the intraperitoneal fluid at surgery was 67%, and a combination of antibiotics covering Gram-positive and Gramnegative bacilli and fungi were given as empiric therapy. Levels of blood coagulation factor XIII decreased preoperatively in all cases surveyed (n=6). Four of 6 cases which required enteral anastmoses had suture insufficiency. These results suggested that the adequate selection of operative method and drainage, with always holding suture insufficiency in mind, played an important role in improving the postoperative outcome for patients with peritonitis underlying CRF.

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