Abstract: TH-PO0908
Bowel Perforation as a Protective Factor Against Peritonitis
Session Information
- Home Dialysis: Utilization Patterns, Complications, and Quality-of-Life Outcomes
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Nguyen, Alison, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Eskander, Kirollos, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Alahmadi, Ziad, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Gross, Matthew William, Johns Hopkins Medicine, Baltimore, Maryland, United States
Introduction
Peritoneal dialysis (PD) catheter migration occurs up to 62.4% of patients and usually without significant complications. However, bowel perforation from a migrating PD catheter is a rare but serious complication associated with high mortality.
Case Description
A 58 year old female with end stage renal disease who was on PD for one year underwent PD catheter replacement 7 months prior to admission. She had catheter malfunction and breakage and discontinued PD independently. She presented for evaluation of her catheter and denied abdominal pain, fever, cloudy effluent, nausea, vomiting, or other symptoms suggestive of infection. Physical examination revealed a soft, non-tender abdomen. The PD catheter exit site was non-erythematous, but the adapter and transfer set were missing, leaving exposed tubing sealed with tape. Laboratory studies showed WBC 7.2 K/cu mm, hemoglobin 12.4 g/dL, platelets 279 K/cu mm, creatinine 11.01 mg/dL, and BUN 111 mg/dL; electrolytes were otherwise stable. CT abdomen and pelvis showed the PD catheter extending into the ascending colon and hepatic flexure. The patient underwent partial colectomy with PD catheter removal without complications.
Discussion
PD catheter migration can occur months to years after placement and can remain undetected until complications such as inadequate dialysis or peritonitis prompting evaluation. Imaging is not routinely performed before catheter removal because the migration path is often predictable and removing it requires minimally invasive techniques. Imaging is reserved for patients with signs of infection or ineffective PD despite prescription optimization. Our patient had an unusual presentation of bowel perforation without peritonitis despite an open catheter exit site, delaying suspicion for intra-abdominal pathology. CT imaging obtained was crucial in identifying the bowel perforation and guiding management. This case emphasizes the importance of imaging before PD catheter removal, even if asymptomatic. It also highlights a unique presentation in which the catheter created an unintentional colostomy, resulting in a sealed perforation that prevented immediate peritonitis.
Teaching Point: Bowel perforation with a PD catheter without signs of infection is uncommon, but warrants proper recognition and treatment. PD Catheter evaluation with imaging is important even if patients are asymptomatic.