Pneumoperitoneum in peritoneal dialysis patients

Resumo

Pneumoperitoneum (PP) in peritoneal dialysis (PD) patients is a rare complication; however it should be considered to avoid an unnecessary laparotomy and that will also compromise the dialytic options. A 70 year-old woman with end-stage renal disease had been on chronic PD with automated night therapy for 21 months, without complications or any signs of peritonitis. She was admitted with a sudden epigastric pain. Tympanic abdomen was present on physical examination. The Tenckhoff catheter exit site looked unremarkable. Laboratory testing showed a normal white cell count. An important PP was visible in chest and abdominal X-rays. Contrast-enhanced abdominal CT scan confirmed a generalised PP distributed in supramesocolic recesses. No extravasation of endoluminal contrast was seen. Dialysis catheter was placed at left lower quadrant. We performed the aspiration of PP using an aseptic technique in Trendelenburg position. Abdominal X-ray showed resolution of PP. In the following day she was asymptomatic but abdominal X-ray revealed a newly developed PP, thus we decided to remove the catheter with no recurrence of PP.