title: Perforative peritonitis caused by appendicitis in a patient on peritoneal dialysis.
abstract: A 46-year-old man on peritoneal dialysis (PD) was hospitalized due to suspicious PD-related peritonitis. Because the patient's abdominal pain was unimproved by conventional antibiotics and multiple bacteria were identified in a smear-sample of PD fluid, endogenous peritonitis was suspected. Perforated appendicitis was finally diagnosed under exploratory laparotomy. In this patient, perforated appendicitis was difficult to diagnose due to the attenuated clinical symptoms and inconclusive results of abdominal computed tomography (CT), even though the positive predictive value of CT is >95% in non-PD patients. Quickly deciding to perform exploratory laparotomy in patients suspected of having endogenous peritonitis is thus important, even when the origin has not been clarified.
authors.affiliation: Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Japan. mmizu@med.nagoya-ac.jp
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizuno
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nonaka
authors.forename: Yumi
authors.initials: Y
authors.lastname: Sei
authors.forename: Shoichi
authors.initials: S
authors.lastname: Maruyama
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ito
mesh_terms: D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D010538:Peritonitis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery