Peritoneoscopic Placement of Peritoneal Dialysis Catheter and Bowel Perforation

Experience of an Interventional Nephrology Program

Arif Asif, Patricia M Byers, Cristovao F. Vieira, Donna Merrill, Florin Gadalean, Jacques J. Bourgoignie, Baudouin Leclercq, David Roth, Merit F. Gadallah

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Bowel perforation is an uncommon but serious complication of peritoneoscopic peritoneal dialysis (PD) catheter insertion. The approach to diagnosis of bowel perforation utilizing this technique has not been previously published. The authors report their experience with the diagnosis and management of bowel perforation in the context of peritoneoscopic placement of PD catheters. Methods: The authors retrospectively reviewed the records of 750 PD catheters inserted over a 12-year period (January 1991 to May 2003) utilizing peritoneoscopic technique. Results: Six (0.8%) patients experienced bowel perforation during the procedure. The diagnosis was made immediately during the procedure in 5 (83%) of the 6 patients. Of these 5, peritoneoscopy confirmed intrabowel position of the cannula by visualizing bowel mucosa (n = 3) and hard stool (n = 1). The fifth patient showed extrusion of fecal matter upon trocar withdrawal before peritoneoscopy. All 5 had emanation of foul-smelling gas through the cannula. Bowel rest and broad-spectrum intravenous antibiotics were initiated. Of the 5, 1 required surgery, whereas the others were discharged home after 3 days. The sixth patient had fever, severe peritoneal irritation, and polymicrobial peritonitis the morning after the procedure. In this patient, no evidence of bowel injury was noted during the procedure except for brief emanation of foul-smelling gas. He required surgical intervention. Conclusion: Bowel perforation can be diagnosed immediately in most patients undergoing peritoneoscopic PD catheter insertion. A majority of these patients can be treated medically. The surgical team should be consulted if the patient shows clinical deterioration or has signs of peritoneal irritation.

Original languageEnglish
Pages (from-to)1270-1274
Number of pages5
JournalAmerican Journal of Kidney Diseases
Volume42
Issue number6
DOIs
StatePublished - Dec 1 2003
Externally publishedYes

Fingerprint

Nephrology
Peritoneal Dialysis
Catheters
Laparoscopy
Gases
Peritonitis
Surgical Instruments
Mucous Membrane
Fever
Anti-Bacterial Agents
Wounds and Injuries

Keywords

  • Bowel perforation
  • Interventional nephrology
  • Peritoneal dialysis (PD)
  • Peritoneoscopy

ASJC Scopus subject areas

  • Nephrology

Cite this

Peritoneoscopic Placement of Peritoneal Dialysis Catheter and Bowel Perforation : Experience of an Interventional Nephrology Program. / Asif, Arif; Byers, Patricia M; Vieira, Cristovao F.; Merrill, Donna; Gadalean, Florin; Bourgoignie, Jacques J.; Leclercq, Baudouin; Roth, David; Gadallah, Merit F.

In: American Journal of Kidney Diseases, Vol. 42, No. 6, 01.12.2003, p. 1270-1274.

Research output: Contribution to journalArticle

Asif, Arif ; Byers, Patricia M ; Vieira, Cristovao F. ; Merrill, Donna ; Gadalean, Florin ; Bourgoignie, Jacques J. ; Leclercq, Baudouin ; Roth, David ; Gadallah, Merit F. / Peritoneoscopic Placement of Peritoneal Dialysis Catheter and Bowel Perforation : Experience of an Interventional Nephrology Program. In: American Journal of Kidney Diseases. 2003 ; Vol. 42, No. 6. pp. 1270-1274.
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abstract = "Background: Bowel perforation is an uncommon but serious complication of peritoneoscopic peritoneal dialysis (PD) catheter insertion. The approach to diagnosis of bowel perforation utilizing this technique has not been previously published. The authors report their experience with the diagnosis and management of bowel perforation in the context of peritoneoscopic placement of PD catheters. Methods: The authors retrospectively reviewed the records of 750 PD catheters inserted over a 12-year period (January 1991 to May 2003) utilizing peritoneoscopic technique. Results: Six (0.8{\%}) patients experienced bowel perforation during the procedure. The diagnosis was made immediately during the procedure in 5 (83{\%}) of the 6 patients. Of these 5, peritoneoscopy confirmed intrabowel position of the cannula by visualizing bowel mucosa (n = 3) and hard stool (n = 1). The fifth patient showed extrusion of fecal matter upon trocar withdrawal before peritoneoscopy. All 5 had emanation of foul-smelling gas through the cannula. Bowel rest and broad-spectrum intravenous antibiotics were initiated. Of the 5, 1 required surgery, whereas the others were discharged home after 3 days. The sixth patient had fever, severe peritoneal irritation, and polymicrobial peritonitis the morning after the procedure. In this patient, no evidence of bowel injury was noted during the procedure except for brief emanation of foul-smelling gas. He required surgical intervention. Conclusion: Bowel perforation can be diagnosed immediately in most patients undergoing peritoneoscopic PD catheter insertion. A majority of these patients can be treated medically. The surgical team should be consulted if the patient shows clinical deterioration or has signs of peritoneal irritation.",
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