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Ischemic colitis in chronic intermittent peritoneal dialysis
Insights
A child with end-stage kidney disease developed ischemic colitis during peritoneal dialysis. Switching to hemodialysis and subsequent kidney transplantation resolved the intestinal condition.
Area of Science:
- Pediatric Nephrology
- Gastroenterology
- Vascular Medicine
Background:
- A pediatric patient with end-stage kidney disease (ESKD) experienced severe gastrointestinal symptoms.
- Symptoms included diarrhea, abdominal distension, cramps, tenesmus, and vomiting, suggestive of colitis.
Observation:
- A 6-year-old boy undergoing peritoneal dialysis presented with severe diarrhea, vomiting, and abdominal pain.
- Radiological imaging revealed mucosal irregularities in the colon, consistent with ischemic colitis.
- Symptoms improved significantly upon transitioning to hemodialysis and discontinuing peritoneal dialysis.
Findings:
- Peritoneal dialysis may be associated with an increased risk of ischemic colitis in pediatric patients with end-stage kidney disease.
- Hemodialysis offers a safer alternative for managing gastrointestinal complications in this population.
- Successful kidney transplantation led to a complete resolution of the ischemic colitis.
Implications:
- This case underscores the importance of considering alternative dialysis modalities in pediatric patients experiencing gastrointestinal complications.
- Early recognition and management of ischemic colitis in patients with end-stage kidney disease are crucial for favorable outcomes.
- Further research is warranted to elucidate the mechanisms linking peritoneal dialysis to ischemic events in the pediatric population.
Abstract:
A 6-year and 8-month-old boy on chronic intermittent peritoneal dialysis for end stage kidney disease presented with severe diarrhea, abdominal distension, cramps, tenesmus and vomiting. Barium enema showed rigidity and irregularity of the mucosa of the sigmoid and distal descending colon, with 'thumb print like' appearance, findings compatible with ischemic colitis. The institution of hemodialysis and discontinuation of the peritoneal dialysis resulted in a marked clinical and radiological improvement. Kidney transplantation performed a month later was associated with a complete cure of his intestinal disease.