Can Catheter Dormancy Be the Only Risk Factor for Delayed Small Bowel Perforation by Peritoneal Catheter?
DOI:
https://doi.org/10.71749/pkj.123Keywords:
Catheters, Indwelling/adverse effects, Intestinal Perforation/etiology, Kidney Failure, Chronic/therapy, Peritoneal DialysisAbstract
With the progression of chronic kidney disease (CKD), it is sensible to prepare patients for the need for renal replacement therapy. Peritoneal dialysis (PD) remains an advantageous option for those with residual kidney function and those who seek treatment adaptable to their daily routine. Timely catheter insertion is recommended to reduce the risk of peri-catheter leak associated with urgent-start PD. We present the case of a 49-year-old woman with CKD due to diabetic renal disease, who underwent peritoneal catheter placement via mini-laparotomy, using Moncrief-Popovich technique. Due to CKD stability, she remained dialysis-free for two years. In September 2024, she presented with pain over the catheter and an adjacent pustule, with identification of Citrobacter braakii in the exudate. She started cotrimoxazole, with clinical improvement. One month later, she reported catheter-tunnel tenderness, occasional vomiting and weight loss. Catheter exteriorization was planned due to symptoms suggestive of uremic syndrome. Upon testing the catheter, the macroscopic appearance of the drained fluid was suggestive of enteric matter, with subsequent confirmation of bowel perforation on computed tomography scan, requiring its removal. While bowel perforation during catheter insertion is uncommon, bowel erosion over time is even rarer, usually described in dormant catheters. Other risk factors described in the literature were not found in our case, posing the question of whether catheter dormancy alone may predispose to delayed bowel perforation. This exceptional case highlights the importance of determining the right time for catheter placement, avoiding prolonged catheter dormancy and bowel erosion, which can compromise the peritoneal membrane and the future feasibility of PD itself.
Downloads
References
Ferreira, A., Borges, A., Abreu, C., Costa, F., Pereira, M., Castro, R., & Barreto, S. (2019). Current guidelines in peritoneal dialysis – Part II. Portuguese Journal of Nephrology & Hypertension, 33(1). https://doi.org/10.32932/pjnh.2019.04.008
Wang, A. Y. M., Brimble, K. S., Brunier, G., Holt, S. G., Jha, V., Johnson, D. W., Kang, S., Kooman, J. P., Lambie, M., McIntyre, C., Mehrotra, R., & Pecoits-Filho, R. (2015). ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis patients Part II – Management of various cardiovascular complications. Peritoneal Dialysis International, 35(4), 388–396. https://doi.org/10.3747/pdi.2014.00278
Crabtree, J. H., Shrestha, B. M., Chow, K., Figueiredo, A. E., Povlsen, J. V., Wilkie, M., Abdel-Aal, A., Cullis, B., Goh, B., Briggs, V. R., Brown, E. A., & Dor, F. J. (2019). Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 update. Peritoneal Dialysis International, 39(5), 414–436. https://doi.org/10.3747/pdi.2018.00232
Topal, U., Ülkü, A., Sarıtaş, A. G., Akçam, A. T., Ünal, A. G., & Eray, İ. C. (2022). Migration of Tenckhoff catheter to sigmoid colon: a rare delayed complication. Case Reports in Surgery, 2022, 1–3. https://doi.org/10.1155/2022/5443787
Iwata, M., Uramatsu, T., Sakamoto, R., Torigoe, K., Yamashita, A., Abe, S., Ota, Y., Kitamura, M., Maeda, A., Mochizuki, Y., Muta, K., Imamura, R., & Nishino, T. (2025). Delayed rectum perforation by a peritoneal dialysis catheter in a peritoneal dialysis patient: a case report and literature review. CEN Case Reports, 14(4), 596–603. https://doi.org/10.1007/s13730-025-00971-w
Vincent, P., Gopinathan, J., & Narayanan, R. (2017). Bowel migration of dormant chronic ambulatory peritoneal dialysis catheter: A vexed problem not avoided by flushing. Indian Journal of Nephrology, 27(6), 484. https://doi.org/10.4103/ijn.ijn_268_16
Fujiwara, M., Soda, T., Okada, T., Kanamaru, H., Inoue, T., & Ogawa, O. (2017). Bowel perforation by a peritoneal dialysis catheter: report of two cases. BMC Nephrology, 18(1), 312. https://doi.org/10.1186/s12882-017-0737-9
Brady, H. R., Abraham, G., Oreopoulos, D. G., & Cardella, C. J. (1988). Bowel erosion due to a dormant peritoneal catheter in immunosuppressed renal transplant recipients. Peritoneal Dialysis International, 8(2), 163–165. https://doi.org/10.1177/089686088800800212
Askenazi, D., Katz, A., Tenney, F., Benfield, M., & Barnhart, D. (2007). An unusual case of peritoneal dialysis malfunction. Kidney International, 72(4), 524. https://doi.org/10.1038/sj.ki.5002232
Ramanarayanan, S., Gupta, S., Vuthaluru, S., & Gamanagatti, S. (2014). Small-Bowel erosion by a functioning peritoneal dialysis catheter. Peritoneal Dialysis International, 34(1), 124–127. https://doi.org/10.3747/pdi.2013.00078
Finkle, S. (2005). Peritoneal Dialysis Catheter Erosion into Bowel: Amyloidosis May be a Risk Factor. Peritoneal Dialysis International, 25(3), 296–297. https://doi.org/10.1177/089686080502500317
Rotellar, C., Sivarajan, S., Mazzoni, M., Aminrazavi, M., Mosher, W. F., Rakowski, T., Argy, W., & Winchester, J. (1992). Bowel perforation in CAPD patients. Peritoneal Dialysis International, 12(4), 396–398. https://doi.org/10.1177/089686089201200412
Markel, T. A., & West, K. W. (2016). Management of Peritoneal Dialysis Catheters that Erode into Bowel: Two Pediatric Case Reports and a Review of the Literature. Peritoneal Dialysis International, 36(6), 680–684. https://doi.org/10.3747/pdi.2016.00029
Trivedi, H., Tan, H. P., Morgan, C., Shapiro, R., & Basil, A. (2010). Colonic perforation by a dormant peritoneal dialysis catheter post renal transplantation. The American Surgeon, 76(8), 908–909. https://doi.org/10.1177/000313481007600843
Khan, S. F., & Rosner, M. H. (2023). Optimizing peritoneal dialysis catheter placement. Frontiers in Nephrology, 3, 1056574. https://doi.org/10.3389/fneph.2023.1056574
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Raquel Pinto, Sandra Pereira, Beatriz Mendes, Maria João Carvalho, Anabela Rodrigues
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
