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Acute abdominal emergencies in patients on long-term ambulatory peritoneal dialysis
1Division of General Surgery, Ottawa General Hospital, Ont.
Objective:
To review intercurrent abdominal emergencies in patients receiving long-term peritoneal dialysis on an ambulatory basis.
Design:
A chart review.
Setting:
Tertiary care referral centre.
Patients:
Seven patients receiving long-term peritoneal dialysis, who suffered an acute abdominal emergency during a 7-year study period.
Interventions:
Laparotomy with appropriate management depending on the findings. Antibiotic therapy and dialysate culture.
Results:
In all patients the acute abdominal process involved the colon: five patients had perforated diverticulitis and two had ischemic colitis. The death rate overall was 57%. Peritonitis in these patients was difficult to differentiate from the peritonitis that occurs commonly in patients on long-term peritoneal dialysis. As a result there was a delay in the initiation of therapy ranging from 2 to 27 days.
Conclusions:
Coincidental abdominal emergency should be considered when patients receiving long-term peritoneal dialysis on an ambulatory basis present with peritonitis that does not respond to established antibiotic protocols and when culture results show evidence of multiple enteric organisms.