Recurrent Peritoneal Pseudocyst: A Rare Complication of Peritoneal Dialysis

An alarming 468,000 people are dependent on dialysis for their end-stage renal disease (ESRD) management in the United States alone. Peritoneal dialysis is a preferred type of dialysis over hemodialysis, considering its initial survival advantage, patient satisfaction, and cost-effectiveness. One of the rare complications of peritoneal dialysis is abdominal and peritoneal pseudocyst formation. Literature regarding the accurate medical management of such peritoneal pseudocysts is scarce. Adding to this, management of recurrent loculated, non-malignant peritoneal pseudocyst poses to be challenging especially when pseudocysts recur after the offending peritoneal dialysis catheter is removed. We report one such case of a patient with a history of ESRD managed on long-term peritoneal dialysis. He presented to the hospital with recurrent abdominal pain which was treated multiple times for spontaneous bacterial peritonitis. Due to recurrence, his peritoneal dialysis was discontinued and hemodialysis was initiated. While on hemodialysis and two years after peritoneal dialysis catheter removal, he presented with sudden onset abdominal distension. Imaging showed loculated peritoneal pseudocyst with multiple loculations. Standard recommendation of surgical removal of cyst could not be performed in this patient due to his coexisting medical co-morbidities. Interventional radiology (IR) guided cyst drainage was attempted but was limited due to multiple locutions. However, IR drainage proved to provide temporary relief and after repeated IR guided drainage, a temporary drainage tube was placed. This subsided the recurrence of fluid-filled pseudocysts and the patient improved. This case emphasizes the importance of follow up of patients who have been or currently are on peritoneal dialysis for early recognition of late-onset complications. Our case also shows the routine challenges faced by the clinician when rare complications arise and standard treatment options cannot be applied.