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Kidney Week

Abstract: TH-PO350

Diagnosing Scrotal Wall Edema in a Patient Undergoing Peritoneal Dialysis

Session Information

  • Home Dialysis - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Bakshi, Dhruv, Saint Vincent Hospital, Worcester, Massachusetts, United States
  • Phachu, Deep, Saint Vincent Hospital, Worcester, Massachusetts, United States
Introduction

Acute genital edema is a well-documented complication of peritoneal dialysis (PD) and is seen in 4-10 % of patients. While most incidents occur via obvious defects in the peritoneal membrane, we present a case of acute scrotal wall edema thought to be due to microtears in the peritoneal membrane.

Case Description

A 46 year old male on PD for the past 20 months presented with complaints of acute scrotal swelling. Shortly after his first dwell via continuous cycling peritoneal dialysis (CCPD), he suffered a severe coughing bout while supine. He awoke the following day with diffuse, bilateral, nonreducible and nontender scrotal swelling. CCDP was temporarily held and swelling improved, but immediately re-occurred after resumption of CCPD. CT of the abdomen and pelvis did not show a patent processus vaginalis, inguinal hernia or other obvious peritoneal membrane defect. Scrotal ultrasound did not show a fluid collection but showed diffuse scrotal wall edema. To confirm that this edema was of PD origin, we added 30 mL of gastrograffin into 1 liter of PD fluid and let this dwell for 3 hours after which repeat CT abdomen and pelvis showed a contrast-enhanced scrotum (Figure 1). CCPD was discontinued and patient was transitioned to intermittent hemodialysis with complete resolution of his edema within 7 days.

Discussion

While scrotal edema is not uncommon in patients on PD, the mechanism for development is usually related to an obvious defect, such as an inguinal hernia or patent processus vaginalis. In our patient however, we hypothesize that microtears in his peritoneal membrane caused by the acute coughing episode may have been the culprit.
To our knowledge, there is no gold-standard test for diagnosing peritoneal microtears in PD, however our method of instilling 30 mL of gastrograffin in 1 liter of peritoneal dialysis fluid may be beneficial in aiding diagnosis. Moreover, we hypothesize that serial imaging done at one, two and three hour intervals may provide additional information regarding the location of such microtears.