Delayed rectum perforation by a peritoneal dialysis catheter in a peritoneal dialysis patient: a case report and literature review

A 60-year-old woman with diabetic nephropathy was diagnosed with end-stage kidney disease and underwent peritoneal dialysis (PD) (X-3 years). Due to decreased residual renal function, she commenced combined PD and hemodialysis (HD) for 6 h once a week (Jan. X year). Seven months later, she visited her maintenance dialysis facility because of fluid leakage from the pubic region and abdominal pain during the dialysate infusion. Tests of the leakage fluid revealed a high glucose concentration, leading to discontinuation of PD and transfer to HD three times a week. She had been referred to a general hospital in her city, where vesical and uterine fistulas were excluded. Consequently, she was referred to our department to investigate the cause of the leakage. She was diagnosed with peritonitis by a physician and was receiving treatment. The lumen of the PD catheter was brownish, indicating possible contamination, leading us to plan its removal. At the time of catheter removal, laparoscopy and intraoperative lower gastrointestinal endoscopy revealed a rectal perforation at the tip of the PD catheter; this was removed after suturing the damaged area. This was a rare case of delayed perforation of the rectum by a PD catheter, during combined PD and HD therapy.