Natroshvili T, Elling T, Dam S A, Vd Berg M, Nap R R H, Hissink R J
Department of Surgery, Treant Health Care Group, Scheper Hospital, Boermarkeweg 60, 7824 AA Emmen, Netherlands.
Department of Internal Medicine, Treant Health Care Group, Scheper Hospital, Boermarkeweg 60, 7824 AA Emmen, Netherlands.
Case Rep Surg. 2020 Feb 20;2020:1309418. doi: 10.1155/2020/1309418. eCollection 2020.
The laparoscopic placement of a continuous ambulatory peritoneal dialysis (CAPD) catheter is a widely used method in patients with end stage renal disease (ESRD). The potential complications of this procedure include perforation of intra-abdominal organs, surgical site infection, peritonitis, catheter migration, catheter blockage, port site herniation, and bleeding. In most cases, bleeding is considered to be an early-onset complication because it mostly occurs within the first seven days after surgery. We report a case of a 68-year-old female patient with a previous history of diabetes mellitus, myelodysplastic syndrome, extensive collateral varices, anaemia, and ESRD due to obstructive uropathy caused by retroperitoneal fibrosis, who presented with persistent blood loss after the laparoscopic placement of a CAPD catheter. Duplex ultrasonography showed that the CAPD catheter was transfixing a superficial epigastric varicose vein, a collateral vein, due to the occlusion of the left external iliac vein. Persistent blood loss after inserting a CAPD catheter without previous imaging of abdominal wall vessels is an indication for further diagnostics.
腹腔镜置入持续性非卧床腹膜透析（CAPD）导管是终末期肾病（ESRD）患者中广泛应用的一种方法。该手术的潜在并发症包括腹腔内器官穿孔、手术部位感染、腹膜炎、导管移位、导管堵塞、端口部位疝和出血。在大多数情况下，出血被认为是一种早期并发症，因为它大多发生在术后的头七天内。我们报告一例68岁女性患者，既往有糖尿病、骨髓增生异常综合征、广泛侧支静脉曲张、贫血病史，因腹膜后纤维化导致梗阻性尿路病并发ESRD，在腹腔镜置入CAPD导管后出现持续失血。双功超声检查显示，由于左髂外静脉闭塞，CAPD导管穿透了一条腹壁浅表静脉曲张（一条侧支静脉）。在未对腹壁血管进行术前成像的情况下，插入CAPD导管后出现持续失血是进一步诊断的指征。
