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Abstract: FR-PO573

Peritoneal Dialysis-Associated Peritonitis Presenting as Catheter Dysfunction

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Mitchell, Kevin, Alpert Medical School of Brown University, Providence, Rhode Island, United States
  • Richman, Katherine, Alpert Medical School of Brown University, Providence, Rhode Island, United States
  • Shah, Ankur, Alpert Medical School of Brown University, Providence, Rhode Island, United States
Introduction

Catheter dysfunction is a common complication among peritoneal dialysis (PD)
patients. Most common causes of one-way dysfunction include constipation, catheter tip
migration, kinks in external tubing, omental wrapping, intraluminal obstruction from fibrin or a
clot, and peritoneal occlusion via adjacent organs. Catheter obstruction presents a major
morbidity to PD patients and is a significant risk factor for modality failure. Up to 20% of
patients are transitioned at least temporarily to hemodialysis when they experience catheter
obstruction. We report an unusual presentation of a usual pathology, a case of peritonitis that
presented initially as catheter obstruction.

Case Description

A 69-year-old man presented for to clinic because he was unable to drain his
PD catheter the night prior. He had no issues with lost dwell or prolonged drain on prior
treatments. On presentation he felt weak, fatigued and lethargic. On further questioning he
had decreased appetite, crampy abdominal pain, diarrhea and abdominal bloating. On arrival,
he was afebrile, had scattered rhonchi on lung exam, no granulation tissue or erythema at the
exit site, and mild LLQ tenderness. We were able to freely instill dialysate but unable to drain.
Alteplase was instilled sequentially for 30 minutes then 2 hours and large strands of fibrin
cleared, permitting drainage of 50cc of cloudy effluent from which gram stain, cell count and
cultures were sent. This sample returned a cell count of 2007 cells/µL with 43% PMNs, and
eventual culture speciating MRSA. He was treated for staphylococcus aureus induced
peritonitis with 3 weeks of intraperitoneal vancomycin. His course was complicated by CDiff
enterocolitis, necessitating the addition of oral vancomycin.

Discussion

Catheter dysfunction and peritonitis are both complications of PD with significant morbidity.
Here we present an atypical presentation of peritonitis, as the presenting symptoms were
purely catheter dysfunction without initial complaint of abdominal pain. While fibrin can cause
both one-way or two-way obstruction and is associated with peritonitis, there are no cases in
the literature of peritonitis presenting this way. It is important to recognize this potential
presentation as peritonitis events should prompt quality improvement efforts for both the
individual patient and the PD program.