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Query: UMLS:C0019270 (hernia)
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Patients treated with peritoneal dialysis (PD) are often required to switch to hemodialysis (HD) temporarily when they develop abdominal wall hernias and dialysate leaks, peritonitis or undergo thoracic or abdominal surgeries. There are significant risks associated with incident hemodialysis including possible central venous catheter infections, thrombosis, and need for invasive procedures. Therefore, strategies to avoid temporary transfer to hemodialysis are desirable. The increased intra-abdominal pressure associated with PD is largely responsible for the issues requiring withholding PD. However, the high intra-abdominal pressure, due to dialysate and body position, can be minimized by making changes to the peritoneal dialysis prescription. The lower intra-abdominal pressure may allow dialysate leaks, hernia repairs, and abdominal incisions time to heal as well as to facilitate earlier resumption of PD after catheter replacement. These strategies help to decrease morbidity and minimize cost to the health care system associated with modality switches and its complications.
Semin Dial 2018 05
PMID:Reducing intra-abdominal pressure in peritoneal dialysis patients to avoid transient hemodialysis. 2938 61

Hernias and peritoneal dialysis (PD) catheter leaks are frequent complications in patients on PD. Transplant recipients have multiple risk factors for delayed wound healing, such as use of corticosteroids and sirolimus, and the presence of uremia and diabetes mellitus. We report a rare occurrence of incisional hernia attributable to internal wound dehiscence after PD catheter placement in a patient on sirolimus.A 34-year-old Latino American man was started on PD training 4 weeks after placement of a PD catheter. Soon after completing training, he developed a large soft bulge close to the PD catheter, with expansile cough impulse suggestive of an incisional hernia filled with peritoneal dialysate. The size of the bulge would decrease after the dialysate was drained. No external leak of dialysate was evident along the exit site.Because of the size of the hernia and the history of it filling soon after dialysis exchange, the feeling was that wound dehiscence had occurred from the peritoneal side, resulting in a large incisional hernia. Because of the large size of the hernia within few weeks of starting PD, sirolimus was suspected to have induced poor wound healing, contributing to formation of the hernia.Sirolimus was stopped, and the patient underwent PD catheter removal and repair of the hernia. A new PD catheter was placed on the opposite side of the abdomen 10 days later. After another 6 weeks, the patient was started on PD. He has been doing well for the 15 months since then, with no recurrence of the hernia. Because he still had residual renal function, he continued to receive low-dose prednisone and mycophenolate sodium. At 10 months after PD start, he stopped the mycophenolate sodium on his own, and we did not resume it. He is still on low-dose prednisone.In end-stage renal disease resulting from failing renal transplantation or from calcineurin inhibitor nephropathy in solid-organ transplantation, sirolimus is a risk factor for wound dehiscence, development of incisional hernia, and peritoneal dialysate leak.Practical tips: Sirolimus should be stopped several days before PD catheter placement. Sirolimus should also be stopped if a PD catheter leak is detected or if incisional hernia develops soon after initiation of PD. Sirolimus should be held till surgical repair of the hernia and removal and replacement of the catheter.
Adv Perit Dial 2017 Jan
PMID:Incisional Hernia After Peritoneal Dialysis Catheter Placement in a Patient on Sirolimus. 2966 29

Abdominal wall hernias are prevalent in patients undergoing peritoneal dialysis (PD). Obturator hernias, first described by Arnaud de Ronsil in 1724, are an uncommon type of hernia where intra-abdominal contents protrude through the obturator foramen. The following case highlights a rare presentation of bilateral obturator hernias with right femoral and inguinal hernia in an 82-year-old woman post-PD. This patient presented with 5 months of bilateral thigh pain and swelling and was found to only have a right-sided obturator hernia on computer tomography (CT) scan. Intraoperatively, bilateral obturator hernias were found along with right inguinal and femoral hernias, which were all repaired laparoscopically with polypropylene mesh. Postoperatively, the patient developed a self-limiting port site hematoma and resumed PD 1 month post-surgery. Due to the high morbidity and mortality from obturator hernias, prompt diagnosis and treatment are imperative. Compared with open hernia repair, laparoscopic hernia repairs are associated with quicker return to usual activities and less persisting pain and numbness. This case portrays that laparoscopic approach to bilateral obturator hernias can be considered in patients post-PD.
Perit Dial Int
PMID:Laparoscopic Mesh Repair of Bilateral Obturator Hernias Post-Peritoneal Dialysis. 3069 36


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