Case Report: Recurring Peritonitis and Dialysis Failure in a Toddler on Peritoneal Dialysis

Area of Science:

• Pediatric Nephrology
• Gastroenterology
• Medical Device Complications

Background:

• A 2-year-old boy with end-stage renal disease (ESRD) secondary to posterior urethral valves (PUV) was managed with peritoneal dialysis (PD).
• The patient presented with recurrent peritonitis, feeding intolerance, and refractory anemia over a 12-month period.
• Despite optimized medical management and family training in PD techniques, the patient's condition did not improve.

Observation:

• Initial investigations, including abdominal X-rays, did not reveal the cause of the patient's persistent symptoms.
• During a peritonitis episode, ultrafiltration failure prompted further imaging.
• A cross-table abdominal X-ray identified an intra-abdominal foreign body, later confirmed to be a needle lodged in the ileum.

Findings:

• Laparoscopic surgery revealed a foreign body (needle) in the ileum, which was successfully removed.
• The peritoneal dialysis catheter was replaced during the same procedure.
• Following surgical intervention, the patient's feeding intolerance and anemia resolved.

Implications:

• This case highlights the importance of considering retained foreign bodies in patients with unexplained refractory symptoms during peritoneal dialysis.
• Diagnostic imaging, particularly when initial findings are unremarkable, may need re-evaluation with adjusted techniques (e.g., cross-table X-ray).
• Successful resolution of complications and resumption of PD underscore the importance of thorough investigation and timely surgical intervention.