Peritoneoscopic placement of peritoneal dialysis catheter and bowel perforation: experience of an interventional nephrology program.
BACKGROUND
Bowel perforation is an uncommon but serious complication of peritoneoscopic peritoneal dialysis (PD) catheter insertion. The approach to diagnosis of bowel perforation utilizing this technique has not been previously published. The authors report their experience with the diagnosis and management of bowel perforation in the context of peritoneoscopic placement of PD catheters.


METHODS
The authors retrospectively reviewed the records of 750 PD catheters inserted over a 12-year period (January 1991 to May 2003) utilizing peritoneoscopic technique.


RESULTS
Six (0.8%) patients experienced bowel perforation during the procedure. The diagnosis was made immediately during the procedure in 5 (83%) of the 6 patients. Of these 5, peritoneoscopy confirmed intrabowel position of the cannula by visualizing bowel mucosa (n = 3) and hard stool (n = 1). The fifth patient showed extrusion of fecal matter upon trocar withdrawal before peritoneoscopy. All 5 had emanation of foul-smelling gas through the cannula. Bowel rest and broad-spectrum intravenous antibiotics were initiated. Of the 5, 1 required surgery, whereas the others were discharged home after 3 days. The sixth patient had fever, severe peritoneal irritation, and polymicrobial peritonitis the morning after the procedure. In this patient, no evidence of bowel injury was noted during the procedure except for brief emanation of foul-smelling gas. He required surgical intervention.


CONCLUSIONS
Bowel perforation can be diagnosed immediately in most patients undergoing peritoneoscopic PD catheter insertion. A majority of these patients can be treated medically. The surgical team should be consulted if the patient shows clinical deterioration or has signs of peritoneal irritation.
Asif
Arif
A
Department of Nephrology, Cleveland Clinic, Naples, FL 34119, USA.
Byers
Patricia
P
Vieira
Cristovao F
CF
Merrill
Donna
D
Gadalean
Florin
F
Bourgoignie
Jacques J
JJ
Leclercq
Baudouin
B
Roth
David
D
Gadallah
Merit F
MF
D000006:Abdomen, Acute / Q000209:etiology; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D002404:Catheterization / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003928:Diabetic Nephropathies / Q000150:complications; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005243:Feces; D005260:Female; D005740:Gases; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000628:therapy; D010535:Laparoscopy / Q000009:adverse effects*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D010538:Peritonitis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013525:Surgical Instruments; D016559:Tacrolimus / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D005740:Gases; D007166:Immunosuppressive Agents; D016559:Tacrolimus