Quinto Ruiz Jorge, Durón Gutiérrez Carlos Eduardo, Romero Moreno Antonio Hiram, González Rosas Stephanie, Castañeda Gutiérrez Alfonsina Daniela
Department of General Surgery, ISSSTE-Tacuba General Hospital, Lago Ontario # 119, Tacuba, Miguel Hidalgo, Zip Code 11410, México City, Mexico.
CEN Case Rep. 2017 Nov;6(2):129-131. doi: 10.1007/s13730-017-0258-1. Epub 2017 Apr 26.
Continuous ambulatory peritoneal dialysis is one of the most commonly used therapies for patients with impaired renal function. Most frequent complications directly related to the catheter usually present within the first weeks, and range from catheter dysfunction to dialysis-associated peritonitis; bowel perforation while placing the catheter is uncommon, and it is usually assessed in the same surgical event. There are, however, delayed complications, and one of the least frequently described is erosion of the catheter into the bowel. We present the case of a 65-year-old man, who shows up at the emergency room referring to "acute diarrhea" associated with his dialysis, it is quickly diagnosed as a bowel perforation and underwent emergency surgery. During the operation we found adhesions compromising small bowel and sigmoid colon, the far end of the dialysis catheter inside the sigmoid colon, with no signs of colonic leakage to the peritoneal space. We removed the dialysis catheter, resected the fibrous borders of the site of insertion and performed a primary closure. The patient evolved satisfactorily and was subsequently discharged to continue with hemodialysis for renal substitution therapy.
持续非卧床腹膜透析是肾功能受损患者最常用的治疗方法之一。与导管直接相关的最常见并发症通常在最初几周内出现，范围从导管功能障碍到透析相关性腹膜炎；置管时肠穿孔并不常见，通常在同一手术过程中进行评估。然而，也有延迟并发症，其中描述最少的一种是导管侵蚀肠管。我们报告一例65岁男性病例，他因与透析相关的“急性腹泻”到急诊室就诊，很快被诊断为肠穿孔并接受了急诊手术。手术中我们发现粘连累及小肠和乙状结肠，透析导管远端位于乙状结肠内，没有结肠向腹膜腔渗漏的迹象。我们取出了透析导管，切除了插入部位的纤维边界并进行了一期缝合。患者恢复良好，随后出院继续进行血液透析以进行肾脏替代治疗。
