PD catheter malfunction due to incisional hernia entrapment

A 69-year-old male with end-stage kidney disease secondary to ischemic cardiomyopathy and peripheral arterial disease presented with early peritoneal dialysis (PD) catheter dysfunction, 14 weeks after laparoscopic insertion of a Di Paolo catheter. The patient experienced slow and incomplete effluent drainage (800 mL out of 1000 mL instilled). Clinical examination revealed a reducible, non-painful right incisional hernia at the site of a prior aortofemoral vascular bypass. Abdominal imaging, including X-ray and CT scan, identified catheter malposition in the right iliac fossa, with the catheter tip trapped in the right incisional hernia sac containing small bowel. Laparoscopic exploration confirmed adhesions and catheter entrapment. After adhesiolysis and repositioning of the catheter into the pouch of Douglas, a functional peroperative test confirmed excellent catheter function. Hernia repair was performed on both sides, with prosthetic mesh on the right and Lichtenstein repair on the left to prevent contralateral hernia development. Postoperative recovery was uneventful, and PD resumed after 3 weeks. This case illustrates a rare cause of PD catheter malfunction due to hernia entrapment. The weight of the catheter may have contributed to its migration into the pre-existing hernia. Systematic screening for abdominal wall hernias in patients with prior vascular or abdominal surgery should be part of pre-PD evaluation to avoid such complications.