'Surgical' peritonitis in the CAPD patient

Area of Science:

• Nephrology
• Gastroenterology
• Surgical Pathology

Background:

• Peritonitis is the most common reason for emergency hospital admissions in continuous ambulatory peritoneal dialysis (CAPD) patients.
• Patients may present with 'surgical' peritonitis due to underlying intra-abdominal pathology, often initially managed as CAPD-related peritonitis.
• Standard conservative treatment for CAPD-related peritonitis may be insufficient for cases involving intra-abdominal emergencies.

Purpose of the Study:

• To investigate nine cases of CAPD patients with peritonitis that failed to respond to standard treatment.
• To evaluate the outcomes of surgical intervention (laparotomy) in these refractory peritonitis cases.
• To highlight the importance of considering intra-abdominal emergencies in non-responsive CAPD peritonitis.

Main Methods:

• Retrospective review of nine CAPD patients presenting with peritonitis.
• Initial treatment with standard conservative measures for CAPD-related peritonitis.
• Subsequent surgical referral and laparotomy for patients who did not improve.

Main Results:

• Six out of nine patients survived following laparotomy.
• Five survivors transferred to long-term hemodialysis.
• One patient successfully returned to CAPD after treatment.

Conclusions:

• Failure to respond to standard peritonitis treatment in CAPD patients should prompt consideration of an intra-abdominal emergency.
• The presence of enteric organisms, such as E. coli, may be a suspicious indicator of surgical pathology.
• Early surgical referral and laparotomy, rather than simple catheter removal, are crucial for decreasing morbidity and mortality in such cases.