Persistent symptomatic intra-abdominal collection after catheter removal for PD-related peritonitis

Area of Science:

• Nephrology
• Infectious Diseases
• Surgical Interventions

Background:

• Severe peritonitis in peritoneal dialysis (PD) patients often necessitates catheter removal.
• Antibiotic treatment post-catheter removal may not resolve all infections.
• Some patients face persistent complications despite catheter removal for peritonitis.

Purpose of the Study:

• To investigate the incidence and outcomes of recurrent loculated peritoneal collections after PD catheter removal for severe peritonitis.
• To assess the success rate of returning to PD in affected patients.
• To evaluate alternative treatment strategies for this patient group.

Main Methods:

• Retrospective review of 30 PD patients with recurrent loculated peritoneal collections post-catheter removal.
• Analysis of peritonitis episodes, catheter removal rates, and subsequent complications.
• Evaluation of percutaneous drainage procedures and PD catheter reinsertion outcomes.

Main Results:

• 1.6% of peritonitis episodes led to recurrent peritoneal collections requiring drainage.
• Median time to diagnosis of collection was 12 days post-catheter removal.
• 83.3% of collections were culture-negative; 56.7% were recurrent, requiring repeated drainage.
• Only 3 patients successfully had their PD catheter reinserted, with diminished solute clearance.

Conclusions:

• Recurrent intra-abdominal collections requiring percutaneous drainage are a significant complication after PD catheter removal for peritonitis.
• The likelihood of a successful return to PD is very low for patients with these collections.
• Direct conversion to long-term hemodialysis should be considered to avoid failed PD catheter reinsertion attempts.