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 language | English |
|---|---|
| Pages (from-to) | 1270-1274 |
| Number of pages | 5 |
| Journal | American Journal of Kidney Diseases |
| Volume | 42 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 1 2003 |
| Externally published | Yes |
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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 journal › Article
}
TY - JOUR
T1 - Peritoneoscopic Placement of Peritoneal Dialysis Catheter and Bowel Perforation
T2 - Experience of an Interventional Nephrology Program
AU - Asif, Arif
AU - Byers, Patricia M
AU - Vieira, Cristovao F.
AU - Merrill, Donna
AU - Gadalean, Florin
AU - Bourgoignie, Jacques J.
AU - Leclercq, Baudouin
AU - Roth, David
AU - Gadallah, Merit F.
PY - 2003/12/1
Y1 - 2003/12/1
N2 - 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.
AB - 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.
KW - Bowel perforation
KW - Interventional nephrology
KW - Peritoneal dialysis (PD)
KW - Peritoneoscopy
UR - http://www.scopus.com/inward/record.url?scp=0344826826&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0344826826&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2003.08.029
DO - 10.1053/j.ajkd.2003.08.029
M3 - Article
VL - 42
SP - 1270
EP - 1274
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 6
ER -