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Intestinal perforation by a peritoneal dialysis catheter in which fungal peritonitis led to diagnosis: a rare case report

  • Hisato Shima
  • Shogo Mizoguchi
  • Yuji Morine
  • Manabu Tashiro
  • Kazuyoshi Okada
  • Jun Minakuchi
  • Shu Kawashima
Case Report

Abstract

Intestinal perforation by a peritoneal catheter is an uncommon, but serious, complication that has a high mortality rate. Intestinal perforation in peritoneal dialysis (PD) patients is difficult to diagnose using symptoms and radiological findings, which may result in a delay in diagnosis. Moreover, intestinal perforation complicated with fungal peritonitis is reportedly a severe condition with a poor prognosis. Herein, we report the case of a 78-year-old man on PD, whose diagnosis of perforative peritonitis was difficult to diagnose preoperatively. He was transferred to our hospital complaining of relapsing PD-related peritonitis due to Klebsiella oxytoca infection 2 months after the insertion of the PD catheter. He had been treated with various antibiotics in the previous hospital. Over the course of treatment, he complained of diarrhea, which was diagnosed as acute enteritis. Upon admission to our hospital, he had no abnormal clinical signs except for a cloudy PD effluent. Blood examination showed a high C-reactive protein level (8.41 mg/dL), a white blood cell count in the PD fluid of 367 cell/µL (neutrophils 55.1%), and the presence of Candida parapsilosis. We initiated antifungal therapy and, during catheter removal, found evidence of intestine perforations by the PD catheter, which were successfully repaired. After catheter removal and intestine repair, he recovered and was discharged to continue undergoing hemodialysis. Based on our case, we recommend that intestine perforations should be considered as a cause of relapsing PD-related peritonitis with abdominal symptoms, particularly watery diarrhea. Furthermore, catheter removal and antifungal administration should be initiated earlier after the diagnosis of fungal peritonitis.

Keywords

Intestinal perforation Relapsing peritonitis Peritoneal dialysis Candida parapsilosis 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Human and animal rights

This article contains no studies involving humans or animals.

Informed consent

Informed consent was obtained from the patient whose case is reported in this study.

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Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  1. 1.Department of Kidney DiseaseKawashima HospitalTokushimaJapan
  2. 2.Department of UrologyKawashima HospitalTokushimaJapan
  3. 3.Department of SurgeryTokushima University Graduate of SchoolTokushimaJapan

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