Abstract: PUB193
Report of Laparoscopic Findings of PD Catheter Replacement after Catheter Removal Due to Refractory Peritonitis in Patients on PD
Session Information
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Io, Hiroaki, Juntendo University Nerima Hospital, Nephrology & Blood Purification Center, Tokyo, Japan
- Iwasaki, Hiroyuki, Juntendo University Nerima Hospital, Nephrology & Blood Purification Center, Tokyo, Japan
- Kano, Toshiki, Juntendo University Nerima Hospital, Nephrology & Blood Purification Center, Tokyo, Japan
- Maeda, Kunimi, Juntendo University Nerima Hospital, Nephrology & Blood Purification Center, Tokyo, Japan
- Suzuki, Yusuke, Juntendo University Faculty of Medicine, Tokyo, Japan
Introduction
There are no reports of laparoscopic findings in peritoneal dialysis (PD)-related peritonitis. We have previously reported laparoscopic imaging findings at the end of PD (KI Reports 2016, Nephrology 2023), and repeated peritonitis is a risk factor for peritoneal degeneration (Semin Dial 2020).
Case Description
We investigated laparoscopic findings observed during catheter removal and re-placement for intractable peritonitis at our hospital. Intraperitoneal findings were variable. In cases of Mycobacterium/MRSA, strong pseudo membrane formation and adhesions were observed, and differences in localization and severity were observed. In all cases several years had passed without complications of encysted peritoneal sclerosis. In the case of Corynebacterium, there was almost no evidence of inflammatory changes in the abdominal cavity, and PD was reintroduced 2 months later. In the case of Pseudomonas aeruginosa, there were strong signs of intraperitoneal adhesions and fibrin occlusion, which led to the removal of the PD catheter. Three years later, due to the patient's strong desire to restart PD, laparoscopic observation showed that the adhesions were improving over time and were easy to remove with forceps, so PD was reintroduced. However, due to insufficient water removal, the patient was used in PD+HD combination therapy.
Discussion
Although it is difficult to infer the intraperitoneal cavity from clinical findings, we believe that the decision to re-place a PD catheter should be made carefully in cases of peritonitis that exhibit strong inflammatory changes, especially Pseudomonas aeruginosa. Laparoscopic findings at the time of PD catheter removal in patients with refractory peritonitis may be helpful in evaluating the possibility of restarting PD.