CT peritoneography in evaluation of pediatric dialysis complications

Intraperitoneal contrast material with CT scanning was used to evaluate three children with multiple recurrences of peritonitis and no obvious source of infection while they were undergoing continuous-cycling peritoneal dialysis. In one child a loculus of uno-pacified dialysate was readily identified, confirming sonographic findings that suggested an inflammatory pseudocyst. In the other two children, contrast material dispersed throughout the peritoneal dialysate, suggesting that recurrent peritonitis occurred from extraperitoneal contamination. CT peritoneography is easily performed with contrast material instilled through the peritoneal dialysis catheter. Combining anatomic imaging with intraperitoneal-fluid dynamics, this technique should provide more complete evaluation of the peritoneal cavity than other imaging methods. While additional evaluation is necessary, our initial experience suggests the usefulness of CT peritoneography in excluding an intraperitoneal source of infection during long-term peritoneal dialysis.