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Abstract: FR-PO564

A Twisted Fate: A Case of PD Catheter Malfunction due to Fallopian Tube Migration

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Thakur, Ajay K., University of Rochester, Rochester, New York, United States
  • Moore, Catherine A., Strong Memorial Hospital, Rochester, New York, United States
Introduction

Management of peritoneal catheter malfunction is an important aspect of peritoneal dialysis care. Most often peritoneal catheter dysfunction is related to omental wrapping, but rarely other intraperitoneal structures can cause outflow obstruction. We report a case of PD catheter dysfunction secondary to fallopian tube migration and wrapping, managed by conversion to hemodialysis.

Case Description

27 y.o.female with ESRD secondary to Class- IV Systemic Lupus Erythematous (SLE) Nephritis initiated peritoneal dialysis (PD) 14 days following catheter insertion. From the outset, she reported severe abdominal pain and cramping associated with filling and draining, occasionally noting blood tinged PD effluent. She was sent to IR for a catheter check, found to have a small non-occlusive filling defect inside the PD catheter around 10 cm from the catheter tip. tPA was instilled in the catheter with transient resolution of the filling defect but no impact on pain symptoms. 6 weeks post catheter insertion she underwent exploratory laparotomy to further evaluate catheter dysfunction. Intraoperative findings were notable for left oviductal fimbriae adherence to the PD catheter in the pouch of Douglas. The fallopian tube was gently separated from the PD catheter and the catheter was removed due to concern about recurrence, as the patient wished to preserve fertility. The patient converted to hemodialysis.

Discussion

Fallopian tube migration, although cited as a rare cause of PD catheter dysfunction, is an important consideration when managing PD associated abdominal pain in female patients. To date, there are 12 reported cases of PD catheter outflow obstruction due to fallopian tube entanglement in the literature, with three reports of oophoropexy resulting in ongoing successful use of the peritoneal catheter. In our case, the decision was made intraoperatively not to attempt oophoropexy or oophorectomy due to the patient's inability to consent and her prior wishes to preserve fertility.