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Ambulatory peritoneal dialysis. Exploratory laparotomy for peritonitis
Archives of Surgery (Chicago, Ill. : 1960)
|December 1, 1984
Summary
Exploratory laparotomy for abdominal sepsis in continuous ambulatory peritoneal dialysis (CAPD) patients is evaluated. Fungal peritonitis with abscesses is life-threatening, requiring aggressive treatment, while bacterial peritonitis may not need surgery.
Area of Science:
- Nephrology
- Surgical Gastroenterology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for end-stage renal disease.
- Abdominal sepsis can complicate CAPD, necessitating careful diagnosis and management.
Purpose of the Study:
- To evaluate the outcomes of exploratory laparotomy in CAPD patients with abdominal sepsis.
- To differentiate management strategies for bacterial versus fungal peritonitis in CAPD.
Main Methods:
- Retrospective review of 134 CAPD patients.
- Analysis of six patients who underwent exploratory laparotomy for abdominal sepsis.
- Comparison of outcomes based on the causative agent (bacterial vs. fungal) and presence of abscess.
Main Results:
- Two patients with bacterial peritonitis without abscesses recovered with antibiotics alone.
- Three patients with fungal abscesses had high mortality (two deaths), with one surviving after recurrent abscess drainage.
- One patient died from intestinal gangrene misdiagnosed as CAPD peritonitis.
Conclusions:
- Fungal peritonitis in CAPD patients is a severe complication associated with high mortality, requiring prompt antifungal therapy and surgical intervention if abscess is present.
- Bacterial peritonitis in CAPD patients should be managed with antibiotics unless clear surgical indications are identified.