Transvaginal dialysate leak via patent fallopian tubes following peritonitis in a CAPD patient

Transvaginal leakage of peritoneal dialysate is an uncommon non-infectious complication of peritoneal dialysis (PD) and may be overlooked in female patients presenting with unexplained vaginal fluid loss. A 78-year-old woman with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) presented with a one-week history of clear per vaginal leakage. This episode developed following an initial presentation of PD peritonitis for which she was receiving antibiotic therapy. She reported the onset of clear vaginal leakage during a routine clinic visit for monitoring of her vancomycin level, prompting her admission for further evaluation. On clinical examination, the patient was afebrile and hemodynamically stable. Abdominal examination was satisfactory, however, speculum examination showed pooling of clear fluid in the vagina without evidence of vaginal or cervical pathology. Subsequent CT peritoneography demonstrated contrast-filled dialysate tracking from the peritoneal cavity, passing through bilaterally patent fallopian tubes into both the endometrial and vaginal cavities. Interestingly, there was no evidence of vaginal wall perforation or an abnormal fistulous connection identified. Given the absence of a correctable fistulous tract, PD was discontinued and the patient was transitioned to hemodialysis, resulting in complete resolution of symptoms. Although rare, physiological tubal patency can provide a conduit for dialysate leakage in PD patients, particularly following recent peritonitis. This mechanism is especially uncommon in post-menopausal women, highlighting the novelty of this case. Clinicians should maintain a high index of suspicion for this rare complication in women presenting with new-onset vaginal fluid loss. Early recognition and appropriate modality change may prevent recurrence.