Gajić Selena, Baralic Marko, Bontic Ana, Sic Aleksandar, Kezic Aleksandra
Nephrology, University Clinical Centre of Serbia, Belgrade, SRB.
Internal Medicine, Faculty of Medicine, University of Belgrade, Belgrade, SRB.
Cureus. 2025 Jun 24;17(6):e86681. doi: 10.7759/cureus.86681. eCollection 2025 Jun.
Peritoneal dialysis (PD) is often contraindicated in patients with extensive prior abdominal surgeries due to the risk of adhesions, catheter malposition, and poor dialysis efficacy. We present a complex case of a 64-year-old male with end-stage kidney disease (ESKD) who experienced repeated arteriovenous fistula (AVF) thromboses and multiple catheter-related bloodstream infections, ultimately exhausting all viable vascular access sites for hemodialysis (HD). Despite prior abdominal surgeries, the patient underwent successful PD catheter insertion following femoral catheter-related sepsis and fungemia. Although initial PD catheter malposition was observed, it was corrected surgically, and PD was initiated, leading to full clinical recovery. This case highlights the potential role of PD as a rescue therapy, even in patients with relative contraindications and no remaining HD access options. It underscores the importance of reconsidering the feasibility of PD in high-risk patients when vascular access is no longer available.
由于存在粘连、导管位置异常及透析效果不佳的风险，腹膜透析（PD）在有广泛既往腹部手术史的患者中往往是禁忌的。我们报告了一例复杂病例，一名64岁终末期肾病（ESKD）男性，经历了反复的动静脉内瘘（AVF）血栓形成和多次导管相关血流感染，最终耗尽了所有可行的血液透析（HD）血管通路部位。尽管有既往腹部手术史，但该患者在发生股静脉导管相关败血症和真菌血症后成功插入了PD导管。虽然最初观察到PD导管位置异常，但通过手术进行了纠正，并开始了PD治疗，最终实现了完全临床康复。该病例突出了PD作为一种挽救治疗的潜在作用，即使在有相对禁忌证且没有剩余HD通路选择的患者中也是如此。它强调了在血管通路不再可用时重新考虑高危患者中PD可行性的重要性。
