Acute abdominal emergencies in patients on long-term ambulatory peritoneal dialysis.
OBJECTIVE
To review intercurrent abdominal emergencies in patients receiving long-term peritoneal dialysis on an ambulatory basis.


METHODS
A chart review.


METHODS
Tertiary care referral centre.


METHODS
Seven patients receiving long-term peritoneal dialysis, who suffered an acute abdominal emergency during a 7-year study period.


METHODS
Laparotomy with appropriate management depending on the findings. Antibiotic therapy and dialysate culture.


RESULTS
In all patients the acute abdominal process involved the colon: five patients had perforated diverticulitis and two had ischemic colitis. The death rate overall was 57%. Peritonitis in these patients was difficult to differentiate from the peritonitis that occurs commonly in patients on long-term peritoneal dialysis. As a result there was a delay in the initiation of therapy ranging from 2 to 27 days.


CONCLUSIONS
Coincidental abdominal emergency should be considered when patients receiving long-term peritoneal dialysis on an ambulatory basis present with peritonitis that does not respond to established antibiotic protocols and when culture results show evidence of multiple enteric organisms.
Wellington
J L
JL
Division of General Surgery, Ottawa General Hospital, Ont.
Rody
K
K
D000006:Abdomen, Acute / Q000175:diagnosis*; D000038:Abscess / Q000175:diagnosis; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003937:Diagnosis, Differential; D004239:Diverticulitis, Colonic / Q000175:diagnosis; D004630:Emergencies; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis; D006801:Humans; D007238:Infarction / Q000175:diagnosis; D007416:Intestinal Perforation / Q000175:diagnosis; D007420:Intestine, Large / Q000098:blood supply; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000175:diagnosis* / Q000382:microbiology; D012810:Sigmoid Diseases / Q000175:diagnosis