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Nonocclusive mesenteric infarction in continuous ambulatory peritoneal dialysis
Z Korzets1, S Ben-Chitrit, J Bernheim
1Department of Nephrology and Hypertension, Meir General Hospital, Kfar Saba, Israel.
Nephron
|January 1, 1996
Summary
Nonocclusive mesenteric infarction is increasingly diagnosed in dialysis patients. This case highlights the need to consider mesenteric ischemia in continuous ambulatory peritoneal dialysis patients, even with peritonitis symptoms.
Area of Science:
- Nephrology
- Gastroenterology
- Vascular Surgery
Background:
- Nonocclusive mesenteric infarction (NMI) is increasingly identified in dialysis patients, with most cases reported in hemodialysis patients.
- NMI has also been documented in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- This report details a case of NMI in a CAPD patient with end-stage renal disease secondary to adult polycystic kidney disease.
Observation:
- The patient presented with symptoms initially mimicking peritonitis or colonic perforation.
- Predisposing factors included orthostatic hypoxemia, postural hypotension, and severe atheromatous changes in the abdominal aorta.
- Diagnosis was delayed due to the subtle presentation and initial misdiagnosis.
Findings:
- Pneumatosis coli of the right colon on computerized tomography (CT) scan was crucial for diagnosis.
- Laparotomy confirmed extensive necrosis of the ascending and transverse colon.
- The patient underwent total colectomy and ileorectal anastomosis.
Implications:
- Mesenteric infarction must be considered in predisposed CAPD patients.
- Peritonitis symptoms can mask NMI, potentially leading to diagnostic delays.
- Early recognition and intervention are critical for improving outcomes in dialysis-associated NMI.