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Pneumoperitoneum in peritoneal dialysis patients
J J Chang1, J Y Yeun, J A Hasbargen
1Department of Medicine, Fitzsimons Army Medical Center, Aurora, CO 80045.
Summary
Pneumoperitoneum in peritoneal dialysis patients is often asymptomatic and not indicative of visceral perforation. This study found most cases had known causes, with only one confirmed perforation among eight patients with pneumoperitoneum.
Area of Science:
- Nephrology
- Radiology
- Gastroenterology
Background:
- Pneumoperitoneum in peritoneal dialysis patients presents a diagnostic challenge due to conflicting data on its clinical significance and association with visceral perforation.
- Prior studies report a wide incidence of pneumoperitoneum (21.2%–33.7%) and variable rates of perforation (5.9%–14.3%) or asymptomatic cases (32.4%–57.1%).
Purpose of the Study:
- To clarify the clinical significance of pneumoperitoneum in patients undergoing peritoneal dialysis.
- To determine the incidence and etiology of pneumoperitoneum in this patient population and its association with visceral perforation.
Main Methods:
- Retrospective review of 694 chest x-ray and acute abdominal series reports from 1982 to 1993 for 75 peritoneal dialysis patients.
- Confirmation of reports by reviewing 363 (52%) of the x-ray films.
Main Results:
- Eight patients (10.7%) experienced 10 episodes of pneumoperitoneum.
- Six of these patients had asymptomatic pneumoperitoneum with known etiologies (post-surgical or catheter manipulation).
- One patient had multiple episodes, some without a clear cause, and one patient had a surgically confirmed colonic perforation with peritonitis.
Conclusions:
- Pneumoperitoneum in peritoneal dialysis patients frequently has a known, benign etiology and is not always associated with visceral perforation.
- Further investigation is warranted for cases of pneumoperitoneum without a clear cause, especially in the context of peritonitis.