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Peritonitis associated with intra-abdominal pathology in continuous ambulatory peritoneal dialysis patients
A H Tzamaloukas1, L E Obermiller, L J Gibel
1Renal Section, Veterans Affairs Medical Service, Albuquerque, New Mexico 87108.
Abstract:
Features helpful in diagnosis and associated with death were evaluated in 26 episodes of peritonitis associated with intra-abdominal pathology (IAP) in continuous ambulatory peritoneal dialysis (CAPD) patients. Culture of multiple enteric pathogens, or of a single unusual enteric pathogen, from the dialysate was useful for diagnosis in 22/26 instances. Other diagnostic features (fecal material in dialysate, diarrhea containing dialysate, increasing free air in the abdominal cavity) were infrequently found. A comparison of patients who died (n = 11, 42%) and those who survived revealed that death was associated with bowel gangrene (5/6 died), recovery of bacteroides from the dialysate, more frequent and severe comorbid conditions (bacteremia, pneumonia, intra-abdominal and intracerebral bleeding, septic shock, hepatic failure), the development of severe malnutrition and thrombocytopenia during infection, and multiple surgical procedures until the diagnosis was established. Peritonitis associated with intra-abdominal pathology in CAPD patients is a severe infection with considerable diagnostic difficulty and high mortality. Early exploratory laparotomy upon suspicion of the nature of the peritonitis, usually raised by the recovery of enteric pathogens from the dialysate, may improve mortality.
Insights
Diagnosing peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients with intra-abdominal pathology (IAP) is challenging. Early surgical intervention is recommended to improve survival rates in these severe cases.
Area of Science:
- Nephrology
- Infectious Diseases
- Gastroenterology
Background:
- Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients often stems from intra-abdominal pathology (IAP).
- This condition presents diagnostic challenges and is associated with significant mortality.
- Understanding diagnostic features and mortality predictors is crucial for patient management.
Purpose of the Study:
- To evaluate diagnostic features of peritonitis associated with IAP in CAPD patients.
- To identify factors associated with mortality in these patients.
Main Methods:
- Retrospective analysis of 26 episodes of peritonitis in CAPD patients with IAP.
- Evaluation of diagnostic clues, including dialysate cultures and clinical signs.
- Comparison of outcomes between patients who survived and those who died.
Main Results:
- Dialysate cultures of enteric pathogens were diagnostic in 22/26 cases.
- Bowel gangrene, recovery of Bacteroides, severe comorbidities, malnutrition, and thrombocytopenia were associated with death.
- High mortality (42%) was observed, with diagnostic delays and multiple surgeries contributing.
Conclusions:
- Peritonitis associated with IAP in CAPD patients is a severe infection with high mortality and diagnostic difficulties.
- Early diagnosis, often prompted by enteric pathogens in dialysate, is critical.
- Prompt exploratory laparotomy upon suspicion of IAP may improve patient survival.