Acute pancreatitis in peritoneal dialysis:  a case report with literature review.
Abdominal pain with a discoloured dialysate in a patient on peritoneal dialysis (PD) is usually attributed to infective peritonitis. Although acute pancreatitis (AP) is not usually a complication of end-stage renal disease, some studies suggest an increased risk especially in patients on PD. We report a case of idiopathic AP in a 41-year-old female on PD who presented with abdominal pain, fever, vomiting and a clear dark dialysate. Initial diagnosis of PD-associated infective peritonitis was made but dialysate cultures proved negative. Serum amylase showed a mild rise and computed tomography revealed necrotising pancreatitis. No common risk factors for AP were identified and she was successfully treated with conservative therapy. A literature review was carried out using a PubMed search with the words 'acute pancreatitis and peritoneal dialysis'. The literature search found a total of 94 cases of AP in the setting of PD. In more than a quarter, no cause for AP was found. Serum amylase was normal in 12.8% of episodes. Complications developed in 25 cases, and 28 patients died from the condition. Therefore, AP can be a rare, but serious complication of PD with a high mortality and must be considered in the differential diagnosis of abdominal pain in a PD patient.
Department of General and Vascular Surgery, Lister Hospital, Stevenage, Hertfordshire, UK.
Farhabanu
F
Manga
Chung Sim
CS
Lim
Lendaba
L
Mangena
Michael
M
Guest
D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000209:etiology*; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D055815:Young Adult