Appendicitis Misdiagnosed as Peritoneal Dialysis-Related Peritonitis: A Case Report

Abdominal pain in patients on continuous ambulatory peritoneal dialysis (PD) is considered a serious, alarming symptom since they are at increased risk for exogenous infection introduced through the peritoneal catheter. Differential diagnosis includes perforated peptic ulcer, cholecystitis, ischemic colitis, appendicitis, diverticulitis, ingestion of foreign body, or malignancy. Typical features of perforation include signs of acute abdomen in addition to free air under the diaphragm detected on imaging. Perforation is an indication of emergency laparotomy, which is the gold standard for diagnosis. We reported a case of a 23-year-old Palestinian male patient who had recently started continuous ambulatory PD. He presented with generalized, colicky abdominal pain associated with nausea and vomiting. He noticed turbid peritoneal fluid while performing daily dialysis sessions. The patient was diagnosed with PD-related peritonitis but had no improvement on intraperitoneal antibiotics. Further evaluation revealed an intraabdominal cause, a perforated appendix. He underwent an urgent laparotomy and switched to hemodialysis. The patient expired due to the complications of his disease. Although PD-related peritonitis is readily diagnosed in patients on continuous ambulatory PD, an underlying intraabdominal pathology should be suspected when the condition is resistant to conventional treatment. Accepting or refuting such a diagnosis can be challenging.