Ounissi M, Sfaxi M, Fayala H, Abderrahim E, Ben Abdallah T, Chebil M, Ben Maiz H, Kheder A
Department of Internal Medicine A and Laboratory of Kidney Pathology LR 00 SP 01, Charles Nicolle's Hospital, Tunis, Tunisia.
Saudi J Kidney Dis Transpl. 2012 May;23(3):552-5.
The dysfunction of the catheter in peritoneal dialysis (PD) is a frequent complication. However, perforation of organs are rare, particularly that of the urinary bladder. This requires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur.
腹膜透析（PD）导管功能障碍是一种常见并发症。然而，器官穿孔很少见，尤其是膀胱穿孔。这就需要对患者进行早期诊断和及时治疗。我们在此报告一例38岁女性患者，她因常染色体显性多囊肾病导致终末期肾病，自2000年11月起接受PD治疗。三年后，她因葡萄球菌性腹膜炎接受治疗。四个月后，她在换液时出现强烈的排尿冲动。对膀胱内液体进行生化分析显示为透析液。通过导管注入造影剂显示膀胱与腹膜腔之间存在瘘管。她接受了膀胱镜下瘘管闭合术，并拔除了PD导管。随后，患者接受血液透析治疗。一个月后，在确认瘘管闭合后，通过手术植入了第二根导管。十天后，她出现导管部位及沿隧道的疼痛，发现隧道沿其走行肿胀。注入造影剂后皮下隧道出现肿胀，但染料未外渗。停止PD，患者重新接受血液透析治疗。膀胱瘘是PD中一种罕见的并发症，当患者在换液时主诉有排尿冲动时应怀疑该诊断，通过造影检查显示膀胱内有染料可确诊。瘘管闭合后可能可以继续进行PD治疗，但可能会复发。
