Pneumoperitoneum in peritoneal dialysis patients; one centre's experience

Area of Science:

• Nephrology
• Radiology
• Gastroenterology

Background:

• Pneumoperitoneum (PP) on chest X-ray (CXR) typically signifies a perforated viscus.
• Peritoneal dialysis (PD) patients may develop PP due to the PD catheter acting as an air entry point, with reported incidences varying widely (4-34%).

Observation:

• This study reviewed 312 upright CXRs from 156 PD patients over three years (2006-2008).
• A total of 11 CXRs showed PP in seven patients, indicating an incidence of 4% in the PD population and 3% of all CXRs performed.
• Two cases of PP were associated with PD catheter insertion complications requiring laparotomy; five were incidental and likely technique-related.

Findings:

• The incidence of PP in this PD cohort was low (<4%), suggesting improved patient training and PD catheter connecting devices have reduced technique-related PP.
• Faulty technique was identified as the cause of incidental PP in symptomatic patients.
• Aspiration of PP in the Trendelenburg position provided immediate symptomatic relief in one patient, who then underwent retraining.

Implications:

• While rare, PP in PD patients necessitates evaluation to exclude visceral perforation.
• Reviewing PD exchange technique is essential after diagnosing PP.
• Aspiration of free air can offer symptomatic relief if PP persists, alongside retraining to prevent recurrence.