In Japan, peritoneal dialysis catheter placement is mainly performed via a mini-laparotomy; therefore, percutaneous catheter insertion is rare. In this study, we conducted percutaneous peritoneal dialysis catheter insertion combined with the stepwise Moncrief and Popovich (SMAP) technique in 2 patients, which produced good outcomes. Using a Veress needle or cannula needle, the abdominal wall was punctured under ultrasound guidance, and the peritoneum was penetrated. A guidewire was advanced to the pelvic floor under fluoroscopy, and then a peel-away sheath was inserted into the abdominal cavity. The peritoneal dialysis catheter was indwelled from the sheath. The internal cuff was positioned within the subcutaneous fat on the rectus abdominis muscle, and the catheter was embedded in the subcutaneous tissue. An exit site was created and peritoneal dialysis was started after 3 and 6 months, respectively, but no leakage was observed. Percutaneous peritoneal dialysis catheter insertion is a minimally invasive technique and can be performed under local anesthesia. Furthermore, when combined with the SMAP technique it is effective at preventing liquid leakage.

This case involved a 54-year-old Japanese male, who had a 35-year history of diabetes and a 5-year history of dialysis. He developed acute episodes of mild disturbances of consciousness, and parkinsonism, such as gait disturbance, bradykinesia, dysarthria, etc. Cranial magnetic resonance imaging (MRI) showed vasogenic edematous lesions in the bilateral basal ganglia. He was diagnosed with diabetic uremic syndrome. After about 2 weeks of rehabilitation and supportive therapy, his neurological symptoms and MRI findings had markedly improved. Only a few cases of diabetic uremic syndrome involving maintenance hemodialysis patients have been reported. The pathogenesis of and optimal treatment for this condition are unclear. Based on our patient’s MRI findings, we consider that poorly controlled glycemia and the breakdown of the blood-brain barrier are involved in the onset of this condition.

A 33-year-old pregnant female presented with mild proteinuria and hypertension at 29 weeks’ gestation. She was treated with oral anti-hypertensives, which failed to control blood pressure. Fetal growth restriction was observed, and the patient was hospitalized at 30 weeks’ gestation. On the same day, her blood pressure rapidly increased, and a headache, upper-right abdominal pain, vomiting, and blurred vision appeared. Blood tests detected elevated liver enzyme levels, thrombocytopenia, and hemolysis. The patient was diagnosed with HELLP syndrome, and an emergency caesarian section was performed. After delivery, she suffered from a consciousness disturbance, and her cranial magnetic resonance imaging findings were suggestive of posterior reversible encephalopathy syndrome. Her liver enzyme levels increased markedly, but peaked shortly after, and her thrombocytopenia and hemolysis also gradually improved. However, a sustained reduction in urinary volume and kidney dysfunction were evident after delivery. Hemodialysis was initiated, and fresh frozen plasma was administered. After a week of dialysis therapy, she gradually recovered, and the hemodialysis was eventually terminated. HELLP syndrome is a type of thrombotic microangiopathy that occurs during gestation. Prolonged kidney dysfunction is rare in patients with HELLP syndrome and usually disappears quickly after the termination of gestation. In this case, progressive and prolonged kidney damage was seen after delivery.