Vincent P, Gopinathan J, Narayanan R
Department of Urology and Nephrology, Aster MIMS Hospital, Malappuram, Kerala, India.
Indian J Nephrol. 2017 Nov-Dec;27(6):484-486. doi: 10.4103/ijn.IJN_268_16.
Delayed bowel erosion by peritoneal dialysis catheter is rare with fewer than thirty cases having been reported in the literature. This complication is usually encountered when the catheter is kept dormant. Two cases have also been reported with catheters in active use. The risk factors for bowel erosion include immunosuppression, diverticulosis, and amyloidosis. An 80-year-old male with chronic kidney disease Stage 5 due to hypertensive nephrosclerosis underwent chronic ambulatory peritoneal dialysis catheter insertion. Due to improvement in the glomerular filtration rate and clinical parameters including extracellular fluid volume status, peritoneal dialysis was not initiated. Weekly catheter flushes were performed. After 5 months, he developed watery diarrhea after a regular flushing episode. Computed tomography scan revealed the catheter displaced into the sigmoid colon with the tip in the rectum. He was managed successfully with catheter removal alone and conservative treatment. He remains asymptomatic at 3-month follow-up. This case is presented to emphasize the fact that delayed bowel erosion can happen with dormant catheter even in the absence of risk factors. Periodic flushing has not prevented this complication in our patient. Perforations can be self-curing when diagnosed early and when patients present without features of peritonitis or sepsis. Such cases can be managed successfully with catheter removal alone.
腹膜透析导管导致的迟发性肠侵蚀较为罕见，文献报道的病例不足30例。这种并发症通常在导管闲置时出现。也有两例报道是在导管仍在使用时发生的。肠侵蚀的危险因素包括免疫抑制、憩室病和淀粉样变性。一名因高血压肾硬化导致慢性肾脏病5期的80岁男性接受了持续性非卧床腹膜透析导管置入术。由于肾小球滤过率及包括细胞外液容量状态在内的临床参数有所改善，未开始进行腹膜透析。每周进行导管冲洗。5个月后，在一次常规冲洗后他出现了水样腹泻。计算机断层扫描显示导管移位至乙状结肠，尖端位于直肠。仅通过拔除导管及保守治疗，他就得到了成功处理。在3个月的随访中，他仍无症状。呈现该病例是为了强调即使没有危险因素，闲置导管也可能发生迟发性肠侵蚀这一事实。在我们的患者中，定期冲洗并未预防这一并发症。穿孔若能早期诊断且患者无腹膜炎或脓毒症表现时可自行愈合。此类病例仅通过拔除导管就能成功处理。
