Related Experiment Videos
Splenic infarct presenting as sterile peritonitis with peripheral embolic phenomena
A Syed1, J L Holley, B Piraino
1Renal-Electrolyte Division, University of Pittsburgh, Pennsylvania.
Summary
Diabetic patients on peritoneal dialysis may develop sterile peritonitis from splenic infarcts. Anticoagulation with warfarin effectively prevents recurrent emboli, suggesting its use in managing this condition.
Area of Science:
- Nephrology
- Cardiology
- Hematology
Background:
- End-stage renal disease (ESRD) patients on long-term peritoneal dialysis (PD) are susceptible to various complications.
- Diabetes mellitus is a leading cause of ESRD and is associated with significant atherosclerotic vascular disease.
Observation:
- Two ESRD patients with diabetes on PD for over two years presented with sterile peritonitis.
- Both patients exhibited splenic infarcts with peripheral embolic phenomena and transient hemoperitoneum.
- Hematologic abnormalities, including polycythemia and dysfibrinogenemia, were noted in the patients.
Findings:
- Splenic infarcts were identified as the cause of sterile peritonitis and embolic events.
- Peritoneal fluid analysis showed elevated white blood cell counts with a predominance of polymorphonuclear cells and minimal red blood cells.
- Anticoagulation with warfarin successfully treated recurrent emboli, with recurrence upon discontinuation.
Implications:
- Splenic infarct should be considered in the differential diagnosis of sterile peritonitis in diabetic patients with atherosclerotic disease, especially with hemoperitoneum.
- Abdominal CT scans can confirm the diagnosis of splenic infarct.
- Long-term warfarin therapy may be necessary to prevent recurrent embolic phenomena in such cases.