Maxted Andrew P, Davies Brian, Colliver Daniel, Williams Alun, Lunn Andrew
Nottingham Renal and Urology Unit, Nottingham Children's Hospital, QMC, Nottingham, UK
Nottingham Renal and Urology Unit, Nottingham Children's Hospital, QMC, Nottingham, UK.
Perit Dial Int. 2017 Nov-Dec;37(6):650-651. doi: 10.3747/pdi.2016.00226.
Peritoneal dialysis (PD) is a well-established form of renal replacement therapy and the practice of leaving catheters post-transplantation widely accepted. We present a rare complication: a child presenting with anal protrusion of the PD catheter.The patient is an 11-year-old boy with a background of renal dysplasia and congenital cutis laxa. Twenty-three weeks after dialysis was commenced, the patient underwent a renal transplant. Thirteen weeks post-transplant, the patient felt an unusual sensation after defecation. The curled end of the catheter was seen protruding from the anus. He was admitted, and investigations showed stable graft function, with abdominal X ray showing no free air.Intraoperative findings showed a small perforation of the sigmoid colon sealed off by adherence of several small intestinal loops. This was repaired laparoscopically after removal of the distal part of the catheter rectum. No peritoneal contamination was seen. He was treated with 5 days of intravenous antibiotics and gradual introduction of enteral feeds. His graft function remained stable throughout.Timing of catheter removal varies, from the time of transplantation to over 3 months post-transplantation. Bowel perforation due to PD catheter insertion is rare and tends to occur at the time of insertion. Anal protrusion of a PD catheter in childhood is extremely rare and unrecorded in a pediatric patient with a connective tissue disorder. Our case highlights that serious complications can occur in the period between transplantation and elective PD catheter removal and that, in the immunocompromised patient, signs can be subtle.
腹膜透析（PD）是一种成熟的肾脏替代治疗方式，移植后留置导管的做法已被广泛接受。我们报告一例罕见并发症：一名儿童出现腹膜透析导管经肛门突出。该患者是一名11岁男孩，有肾发育不良和先天性皮肤松弛症病史。开始透析23周后，患者接受了肾脏移植。移植后13周，患者排便后感觉异常。可见导管卷曲端从肛门突出。他入院后，检查显示移植肾功能稳定，腹部X线显示无游离气体。术中发现乙状结肠有一小穿孔，被几个小肠袢粘连封闭。在切除导管直肠远端后，通过腹腔镜进行了修复。未见腹膜污染。给予5天静脉抗生素治疗，并逐渐引入肠内营养。他的移植肾功能始终保持稳定。导管拔除时间各不相同，从移植时到移植后3个月以上。因腹膜透析导管插入导致的肠穿孔很少见，且往往发生在插入时。儿童腹膜透析导管经肛门突出极为罕见，在患有结缔组织疾病的儿科患者中尚无记录。我们的病例强调，在移植和择期拔除腹膜透析导管之间的时间段可能会发生严重并发症，而且在免疫功能低下的患者中，症状可能很轻微。
