Abstract: FR-PO548
An Unusual Vaginal Discharge: The First Reported Case of Peritoneal Dialysis Catheter-Fallopian Tube Fistula
Session Information
- Dialysis and Vascular Trainee Case Reports
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 2000 Women's Health and Kidney Diseases
Authors
- Kennedy, William J., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Mandalapu, Rajendra, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Iskandar, Sandia, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Singh, Manisha, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Karakala, Nithin, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Introduction
Complications of peritoneal dialysis(PD) include obstructions and fistulas. Obstructions can result from various reasons including omental or fallopian tube wraps while communications/fistulas between the bladder and colonic walls are also possible. Vaginal discharge of PD fluid with an anatomically intact pelvis is not yet reported.
Case Description
The patient is a 42-year old African American woman with a past medical history of Lupus Nephritis and End-Stage Renal Disease on Peritoneal Dialysis(PD) for the past 5 years with poor compliance and repeated episodes of peritonitis. The patient reported an episode of abdominal pain and reported intermittent incontinence with painless vaginal discharge. These symptoms were not initially considered to be related to PD. She was treated for repeat peritonitis and vaginitis/cervicitis. She also reported that the discharge happens only during the fills on PD. She was admitted for peritonitis and PD was resumed. Within an hour of resuming dialysis, she had a large amount of fluid leak from the vagina. Obstetrics and Gynecology performed a pelvic examination that did not reveal an overt fistula or any abnormal findings. CT scan with contrast showed PD catheter coiled in the pouch of Douglas. The contrast went through the catheter to the right fallopian tube, entered the uterus and extended through the cervix into the vagina. It appears that the patient had formed collections on the pelvic floor, and one had PD Cath in direct communication with the fallopian tube. The patient underwent an open exploratory lap with salpingectomy. She transitioned to hemodialysis electively.
Discussion
This case highlights the differentials of vaginal discharge in a woman on PD. The patient had reported various concerns like possible intermittent incontinance, sudden vaginal discharge. All these symptoms were not considered to be related to PD, thus delaying diagnosis. Her abdominal pain was related to peritonitis and loculating collection in the abdomen. The painless vaginal discharge was happening through natural communications between the peritoneum, fallopian tube, and vagina. Abnormal fistulas are possible with excoriations and infections leading to friable organs, as also through natural orifices. Vaginal discharge in PD patient should lead to detailed exam and imaging.