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Query: UMLS:C0000727 (acute abdomen)
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We present here the case of a continuous ambulatory peritoneal dialysis (CAPD) patient who developed sclerosing calcifying peritonitis with gross macroscopic calcification of the small bowel, a rare and life-threatening complication of sclerosing peritonitis. A 40-year-old female had been on CAPD for 7 years. A peritoneal biopsy during an open cholecystectomy for cholelithiasis showed sclerosing peritonitis, but the patient refused to change dialysis modality. She remained free of symptoms for 3 years, but then was admitted with cloudy effluent, abdominal pain, and referred pain to the left shoulder. A white blood cell count showed 25,000 cells/microL, and a peritoneal cell count showed 1000 cells/microL. An abdominal computed tomography scan was nondiagnostic. The patient was started on intraperitoneal antibiotics, but 3 days later she was taken for surgery because of acute abdomen. Laparotomy revealed a tanned and thickened peritoneum and a small bowel with significant fibrosis and foci of calcification on the antimesenteric surface. Enterectomy and primary anastomosis was performed. Pathology revealed extensive mural fibrosis, calcium deposition, and localized inflammatory infiltration of the small bowel. The patient developed an anastomotic leak and, despite a second operation, died in the intensive care unit from septic shock. Although some authors report successful outcomes in similar cases by using surgery or other treatments (parenteral nutrition, immunosuppression), or both, we urgently recommend that, if sclerosing calcifying peritonitis is diagnosed, the patient be switched promptly to hemodialysis.
Adv Perit Dial 2006
PMID:Gross calcification of the small bowel in a continuous ambulatory peritoneal dialysis patient with sclerosing peritonitis. 1698 50

Peritoneal dialysis (PD) catheters may be inserted blindly, surgically, and either by laparoscopic, peritoneoscopic, or fluoroscopic approach. A modified fluoroscopic technique by adding ultrasound-assistance was performed in the present study to ensure entry into the abdominal cavity under direct ultrasound visualization. From March 2005 to May 2007, ultrasound-fluoroscopic guided placement of PD catheters was attempted in 32 end-stage renal disease (ESRD) patients. Preoperative evaluation was performed on all patients prior to the procedure. After initial dissection of the subcutaneous tissue anterior to the anterior rectus sheath, the needle was inserted into the abdominal cavity under the guidance of ultrasound. The position of the epigastric artery was also examined using ultrasonography to avoid the risk of arterial injury. PD catheters were successfully placed in 31 of the 32 ESRD patients using this technique. In all of these patients, the needle could be seen entering the abdominal cavity using an ultrasound. In one patient the procedure was abandoned because of bowel puncture by the micro-puncture needle that was inadvertently advanced into a loop of bowel. This patient did not develop acute abdomen nor needed any intervention. One patient died 4 days after placement of the catheter of unrelated causes. One patient was started on acute peritoneal dialysis the same day of catheter placement without any complications. The rest of the patients started peritoneal dialysis within 2-6 weeks of catheter placement. None of the patients had bleeding related to arterial injury as ultrasound was able to visualize the epigastric artery. Our experience shows that ultrasound-fluoroscopic technique is minimally invasive and allows for accurate assessment of the entry into the abdominal cavity. This technique can avoid the risk of vascular injury altogether.
Semin Dial
PMID:Ultrasound/fluoroscopy-assisted placement of peritoneal dialysis catheters. 1799 Dec 13