Letter to the Editor Am J Nephrol 1992:12:199-200
Barbara Wood William C. Abbott Dale G. Erickson Antonios H. Tzamaloukas Colo-Rectal, Oncological Surgery. Albuquerque, N.M., USA
Delayed Infectious Complications of Peritoneal Dialysis Catheters
In patients on continuous ambulatory peritoneal dialy sis (CAPD), infections of the exit site or tunnel of the peri toneal catheter may lead to catheter loss [ 1]. Furthermore, abscesses may develop on the sites of previous peritoneal catheter tracts long after removal of the catheter [2], We report a case of abscess formation on the site of the tract of a peritoneal catheter lost 6 years earlier because of tun nel infection. A 58-year-old man was started on CAPD in June 1981 by a twocuff TenckhofT catheter placed through the left paramcdial route. He had one episode of Acinetobacier calcoacelicus peritonitis in Decem ber 1981. The Tenckhoff catheter was removed in July 1984 because of tunnel and exit site infection caused by Staphylococcus aureus. A Tenckhoff catheter placed by a right paramedial approach was lost to S. aureus exit site infection 1 year later. In January 1991.2,379 days after removal of the first catheter, he was admitted with a 2-month history' of malaise, severe constipation with intermittent bouts of diarrhea, anorexia and weight loss (2 kg)
followed by fever (38.6 °C), left lower abdominal quadrant pain, 3-4 hard stools with bright red blood in the past 10 days and one episode of bloody diarrhea on the day of admission. His abdomen was dis tended with decreased bowel sounds and marked tenderness and guarding of his left lower quadrant. Large hemorrhoids, not bleeding during examination, were also noted. Leukocytosis (12.100 cells/ mm3) and left shift (neutrophils 70%, bands 10%) were present in the blood smear. Prothrombin time was prolonged (18.7s with a control of 12.1 s) without any other abnormality in coagulation studies or liver function tests. The prothrombin time was corrected to normal by in vitro addition of normal plasma, indicating a deficit in a vitamin-K-dependent procoagulant. The diagnosis of diverticulitis was entertained. Colonoscopy and barium enema were negative, but computed tomography showed a left anterior abdominal wall mass with multiple loculations (fig. 1). Exploration revealed a multi-loculated abscess inside the left rectus muscle, starting from the scar of the old tunnel infection tract and dissecting into the scrotum. The abscess was drained. Culture of the pus grew penicillin-resistant S. aureus having identical antibiotic sensitivities with the S. aureus strains cultured from the peritoneal catheter tunnel abscesses in 1984 and 1985. The patient recovered slowly over the next few weeks.
.
Received: August I. 1991 Accepted: April 17,1992
William C. Abbott, MD Colo-Rcctal, Oncological Surgery 711 Encino Place NE Albuquerque. NM 87108 (USA)
1992 S. Karger AG. Basel 0250—8095/92/0123— 0199 $2.75/0
Downloaded by: Stockholm University Library 130.237.165.40 - 1/19/2019 10:56:10 AM
Fig. 1 Abdominal computed tomogram demonstrating a multiloculated. thick-wall mass in the anterior abdominal wall (arrow).
hemorrhoidal origin and abdominal distention due to either constipation or the effects of 5. aureus toxins created a clinical picture strongly suggesting diverticulitis. Abdominal computed tomography is helpful in differen tiating between intra-abdominal and abdominal wall ab scesses.
References
I
2
200
Wood/Abbott/Erickson/Tzamaloukas
Piraino B, Bemandini J. Sorkin M: The in fluence of peritoneal catheter exit site infec tions on peritonitis, tunnel infections and cath eter loss in patients on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 1986;8: 436-440. Atkinson RC. Rubin J: Complications of Tenckhoff catheters post removal. ASAIO Trans 1990;36:M501-502.
Delayed Infectious Complications of Peritoneal Dialysis Catheters
Downloaded by: Stockholm University Library 130.237.165.40 - 1/19/2019 10:56:10 AM
Abdominal wall abscess in the tracts of previous peri toneal dialysis catheters can develop several years after catheter removal. Prompt diagnosis and treatment de pends on awareness of clinicians about this remote com plication of CAPD. The clinical picture can be confused with that of intra-abdominal septic processes as it was ini tially in this case in which rectal bleeding probably of
Barbara Wood William C. Abbott Dale G. Erickson Antonios H. Tzamaloukas Colo-Rectal, Oncological Surgery. Albuquerque, N.M., USA
Delayed Infectious Complications of Peritoneal Dialysis Catheters
In patients on continuous ambulatory peritoneal dialy sis (CAPD), infections of the exit site or tunnel of the peri toneal catheter may lead to catheter loss [ 1]. Furthermore, abscesses may develop on the sites of previous peritoneal catheter tracts long after removal of the catheter [2], We report a case of abscess formation on the site of the tract of a peritoneal catheter lost 6 years earlier because of tun nel infection. A 58-year-old man was started on CAPD in June 1981 by a twocuff TenckhofT catheter placed through the left paramcdial route. He had one episode of Acinetobacier calcoacelicus peritonitis in Decem ber 1981. The Tenckhoff catheter was removed in July 1984 because of tunnel and exit site infection caused by Staphylococcus aureus. A Tenckhoff catheter placed by a right paramedial approach was lost to S. aureus exit site infection 1 year later. In January 1991.2,379 days after removal of the first catheter, he was admitted with a 2-month history' of malaise, severe constipation with intermittent bouts of diarrhea, anorexia and weight loss (2 kg)
followed by fever (38.6 °C), left lower abdominal quadrant pain, 3-4 hard stools with bright red blood in the past 10 days and one episode of bloody diarrhea on the day of admission. His abdomen was dis tended with decreased bowel sounds and marked tenderness and guarding of his left lower quadrant. Large hemorrhoids, not bleeding during examination, were also noted. Leukocytosis (12.100 cells/ mm3) and left shift (neutrophils 70%, bands 10%) were present in the blood smear. Prothrombin time was prolonged (18.7s with a control of 12.1 s) without any other abnormality in coagulation studies or liver function tests. The prothrombin time was corrected to normal by in vitro addition of normal plasma, indicating a deficit in a vitamin-K-dependent procoagulant. The diagnosis of diverticulitis was entertained. Colonoscopy and barium enema were negative, but computed tomography showed a left anterior abdominal wall mass with multiple loculations (fig. 1). Exploration revealed a multi-loculated abscess inside the left rectus muscle, starting from the scar of the old tunnel infection tract and dissecting into the scrotum. The abscess was drained. Culture of the pus grew penicillin-resistant S. aureus having identical antibiotic sensitivities with the S. aureus strains cultured from the peritoneal catheter tunnel abscesses in 1984 and 1985. The patient recovered slowly over the next few weeks.
.
Received: August I. 1991 Accepted: April 17,1992
William C. Abbott, MD Colo-Rcctal, Oncological Surgery 711 Encino Place NE Albuquerque. NM 87108 (USA)
1992 S. Karger AG. Basel 0250—8095/92/0123— 0199 $2.75/0
Downloaded by: Stockholm University Library 130.237.165.40 - 1/19/2019 10:56:10 AM
Fig. 1 Abdominal computed tomogram demonstrating a multiloculated. thick-wall mass in the anterior abdominal wall (arrow).
hemorrhoidal origin and abdominal distention due to either constipation or the effects of 5. aureus toxins created a clinical picture strongly suggesting diverticulitis. Abdominal computed tomography is helpful in differen tiating between intra-abdominal and abdominal wall ab scesses.
References
I
2
200
Wood/Abbott/Erickson/Tzamaloukas
Piraino B, Bemandini J. Sorkin M: The in fluence of peritoneal catheter exit site infec tions on peritonitis, tunnel infections and cath eter loss in patients on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 1986;8: 436-440. Atkinson RC. Rubin J: Complications of Tenckhoff catheters post removal. ASAIO Trans 1990;36:M501-502.
Delayed Infectious Complications of Peritoneal Dialysis Catheters
Downloaded by: Stockholm University Library 130.237.165.40 - 1/19/2019 10:56:10 AM
Abdominal wall abscess in the tracts of previous peri toneal dialysis catheters can develop several years after catheter removal. Prompt diagnosis and treatment de pends on awareness of clinicians about this remote com plication of CAPD. The clinical picture can be confused with that of intra-abdominal septic processes as it was ini tially in this case in which rectal bleeding probably of
