[The role of CT peritoneography as diagnostic tool in patient on peritoneal dialysis with dialysate leakage]

Peritoneal dialysis (PD) can be considered as first method for dialytic treatment because improved quality of life and patient survival compared to hemodialysis. The most frequent complications of PD are peritonitis, peritoneal catheter exit site infection and mechanical complications as dialysate leakage. We present a 62 year old female patient with end-stage renal disease caused by poststreptococcal glomerulonephritis. One month after laparoscopic placement of peritoneal catheter patient started with continuous ambulatory peritoneal dialysis. Few weeks after starting the procedure enlargement of anterior abdominal wall close to the exit site of peritoneal catheter was noticed. Enlargement was disappeared after decreasing intraabdominal pressure with lowering volume of dialysate. Also, patient started with automated peritoneal dialysis (APD), but after abdominal straining enlargement of anterior abdominal wall was present again. Computed tomography of abdomen and pelvis with placement of contrast in dialysate (CT peritoneography) was performed. Imaging revealed dialysate leakage from peritoneal cavity to subcutaneous tissue. PD was temporarly stopped, peritoneal catheter removed and hernioplasty was made. After four weeks new peritoneal catheter was implanted and APD was successfully started (without dialysate leakage). CT peritoneography have important role as diagnostic tool for discovering dialysate leakage. If conservative management was unsuccessfull, surgical treatment is necessary.