Severe peritonitis developed in two patients on continuous ambulatory peritoneal dialysis (CAPD). Both patients died, and autopsies were performed.
Case I: A 30-year-old man with chronic renal failure had started CAPD from November, 1980. He had been in good condition until November 27, 1982, when he suffered from abdominal pain and noticed turbidity of the dialysate return. Thus, he was admitted to our hospital.
On admission, severe tenderness and resistance was observed over the whole abdominal wall. He had a temperature at of 38°C. The peritoneal fluid was turbid, and the fluid culture was positive for pseudomonas aeruginosa.
After admission, peritoneal dialysis was started with IP. and IV. antibiotics for lavage. But, in spite of the therapy, clinical improvement was not obtained. Peritoneal catheter removal and reinsertion of a new catheter were undertaken, but the peritonitis did not improve.
The patient gradually developed sepsis and died two weeks later. The autopsy revealed a hen's-egg sized subphrenic abscess.
Case II: 55-year-old man with chronic renal failure started CAPD from July, 1982. August 15, 1983, he noticed abdominal pain and turbidity of dialysate return, so he was admitted to our hospital.
On admission, severe abdominal tenderness was observed, and the peritoneal fluid was turbid. The fluid culture was positive for staphylococcus aureus.
After admission, peritoneal dialysis with IP. and IV. antibiotics was performed, but clinical improvement was not obtained.
Even after the catheter removal, the peritonitis lasted for (more than) two months, and the patients died of subarachnoidal hemorrhage on November 12, 1983.
The autopsy revealed abscess in the hepatic flexure.
Though both patients had intra-abdominal abscess, neither Ga-scintigraphy nor ultrasonic survey had revealed any abscess.
Our experiences suggest that we must consider the possibility of intra-abdominal abscess formation whenever peritonitis persists and does not respond to the usual treatment, and, if we can obtain a diagnosis of intra-abdominal abscess, radical procedures, including laparotomy, may be required.
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