Pneumoperitoneum in peritoneal dialysis patients.

There has been recent controversy regarding the clinical significance of pneumoperitoneum in patients undergoing peritoneal dialysis. The incidence of pneumoperitoneum has been estimated to be 21.2% to 33.7% in prior studies of peritoneal dialysis patients. Of the peritoneal dialysis patients with pneumoperitoneum, only a small percentage (5.9% to 14.3%) had documented visceral perforations. The controversy arises in that anywhere from 20% to 100% of peritoneal dialysis patients with pneumoperitoneum and peritonitis had visceral perforation, and 32.4% to 57.1% of chronic ambulatory peritoneal dialysis patients had asymptomatic pneumoperitoneum of unknown etiology. These disparate incidences made clinical interpretation of pneumoperitoneum difficult. In addition, prior study result disagreed as to the usefulness of the extent of pneumoperitoneum in predicting visceral perforation. We retrospectively reviewed 694 chest x-ray film and acute abdominal series reports from 1982 to 1993 in 75 peritoneal dialysis patients, with 9.3 +/- 1.3 (mean +/- SEM) x-ray films per patient. The reports were confirmed by reviewing 363 x-ray films (52%). Eight patients (10.7%) had 10 episodes of pneumoperitoneum. Six of these eight patients had asymptomatic pneumoperitoneum from a known etiology: four had undergone abdominal surgery for catheter placement the prior week and two had catheter manipulation immediately preceding the x-ray. One patient had three episodes of pneumoperitoneum: one after catheter placement and two not associated with a known etiology for pneumoperitoneum while on the cycler. One patient had a surgically confirmed colonic perforation with a large pneumoperitoneum and peritonitis.(ABSTRACT TRUNCATED AT 250 WORDS)