Abstract: FR-PO646
Spontaneous Rupture of Peritoneal Dialysis Catheter with No Drainage Problem
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 703 Dialysis: Peritoneal Dialysis
Authors
- Rodriguez-Santos, Ricardo, UTHSCSA, Helotes, Texas, United States
- Bansal, Shweta, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Garcia-Everett, Ashley, UTHSCSA, Helotes, Texas, United States
Introduction
Background: Spontaneous rupture of the intraperitoneal portion of peritoneal dialysis (PD) catheter is a rare complication and usually presents with drainage failure and PD related infection. Here we present a case of PD catheter rupture who presents with peritonitis; however, intact out- and in-flow.
Case Description
Case report: A 32-year female with end stage renal disease due to hypertension on PD for 5 years presented with 2 days of mild grade fever, nausea, abdominal pain and cloudy peritoneal fluid. She was managed on CCPD with a two-cuff coiled Tenckhoff catheter. She practiced daily exit site care using topical exsept and alternative gentamicin/bactroban cream. She had 2 episodes of exit site infections with pseudomonas and coagulase negative staphylococcus, respectively 3 years prior to presentation but no peritonitis. On examination, she was afebrile, tachycardiac and had diffuse abdominal tenderness; however, no findings of exit site infection. PD fluid revealed 12,000 WBC/µl with 98% neutrophils and culture grew Pseudomonas aeuroginosa. CT scan done for abdominal pain showed discontinuity of the PD catheter within the anterior abdominal wall soft tissue. Later, fluoroscopic study with gastrograffin confirmed the fracture site in subcutaneous fat with pooling of contrast around the site and drainage of a portion of contrast into peritoneal cavity suggestive of a track. Of note, the patient had an episode of exit site trauma with mild bleeding 8 months prior to the presentation but no infection. Since then she had intermittent issues with long drain time (about 30 minutes) which improved somewhat with laxatives. In addition, she maintained good solute and volume clearance throughout this period. Finally, she underwent surgical removal of the fractured catheter and found to have abscess around the fracture site which was evacuated. The patient had an uneventful recovery and PD was resumed successfully with a new catheter after few months.
Discussion
Conclusion: This is a rare case of PD catheter rupture which likely occurred slowly over time allowing the formation of a soft tissue track and uninterrupted PD therapy but with long drain time. This case highlights the need to be vigilant about these rare events even with mild catheter flow issues.