Culture-negative peritoneal dialysis peritonitis associated with pancreaticoduodenocystotomy leak of a pancreas transplant.
BACKGROUND
Peritoneal dialysis (PD) peritonitis is usually caused by infection and less commonly by a sterile inflammatory reaction.


METHODS
The authors report the case of a kidney-pancreas transplant recipient who was receiving PD after kidney transplant rejection 5 years after transplantation. The patient had a viable pancreas transplant. He had abdominal pain associated with cloudy PD effluent. The PD leukocyte count was elevated with a predominance of monocytic leukocytes.


RESULTS
Blood, urine, and PD effluent cultures were negative. An ultrasound scan of the transplanted kidney and a computerized tomography (CT) scan of the abdomen and pelvis did not identify the cause of the peritonitis. Foley catheter decompression of the bladder resulted in improvement of the abdominal pain and PD effluent leukocytosis. Twenty-five days later, the patient again experienced abdominal pain and cloudy PD effluent. Cultures of blood and PD effluent were again negative. CT scanning and cystoscopy of the transplanted pancreas identified a leak at the pancreaticoduodenocystotomy anastamosis. Urinary bladder decompression was followed by surgical exploration that identified an erosion of the distal transplanted duodenum, necessitating enteric diversion of the transplanted pancreas's exocrine secretions. The patient underwent conversion to hemodialysis, and the pancreas transplant continued to function well. He has subsequently received a living related kidney transplant.


CONCLUSIONS
This is the first reported case of noninfectious PD peritonitis caused by pancreaticoduodenocystotomy leak in a patient with a functional pancreas transplant.
Terrado
Lourdes T
LT
Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
Wilmer
William A
WA
Pesavento
Todd E
TE
D015746:Abdominal Pain / Q000209:etiology; D000714:Anastomosis, Surgical; D001202:Ascitic Fluid / Q000166:cytology; D003559:Cystostomy; D004385:Duodenostomy; D004386:Duodenum / Q000637:transplantation; D005119:Extravasation of Diagnostic and Therapeutic Materials; D006084:Graft Rejection / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D016030:Kidney Transplantation; D007958:Leukocyte Count; D008751:Methylene Blue; D010179:Pancreas / Q000601:surgery*; D016035:Pancreas Transplantation / Q000379:methods; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D012008:Recurrence; D012086:Reoperation
D008751:Methylene Blue