Perforation of the ascending colon during implantation of an indwelling peritoneal catheter: a case report
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CASE REPORT
Perforation of the ascending colon during implantation of an indwelling peritoneal catheter: a case report Maria Paparoupa1* , Henning Wege2, Anna Creutzfeldt1,2, Marcial Sebode2, Faik G. Uzunoglu3, Olaf Boenisch1, Axel Nierhaus1, Jakob R. Izbicki3 and Stefan Kluge1
Abstract Background: Tunneled peritoneal drainage catheters are described as an effective and relatively safe method in the management of malignant and non-malignant refractory ascites. Therapeutic advantages, linked to their use, are self-management of ascites and palliative care at home. Complications occur rarely. We describe an ascending colon perforation after implantation of a peritoneal drainage in a patient with refractory ascites due to liver cirrhosis. Case presentation: The 68-year-old male was admitted to the intensive care unit due to severe community acquired pneumonia. The ascites drainage was inserted in order to reduce the intra-abdominal pressure and enable appropriate ventilation. A few hours later, bowel content could be detected in the tube and an abdominal computed tomography confirmed the intestinal perforation. Notably, there was no pneumoperitoneum and peritonitis had not yet set in. The catheter was removed during an emergency laparotomy and sutured closure of both perforation sites was performed. Conclusion: Patients with septated ascites and intraperitoneal adhesions are at potential higher risk of bowel perforation during implantation of an indwelling peritoneal catheter. A mini-laparotomy is, therefore, necessary in order to ensure safe implantation and positioning of the catheter in those cases. Keywords: Refractory ascites, Liver cirrhosis, Paracentesis, Ascites drainage, Tunneled catheter Background Tunneled peritoneal drainage catheters are described as effective and relatively safe in the management of malignant and non-malignant refractory ascites [1]. It has been shown that the need for paracentesis in patients with refractory ascites, due to terminal liver disease, may be reduced without compromising renal function [2]. In the setting of malignant ascites, tunneled peritoneal drainage catheters facilitate self-management and palliative care at home [3]. The most common complications been *Correspondence: [email protected]; [email protected] 1 Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany Full list of author information is available at the end of the article
reported are catheter-associated infections, fluid leakage around the entry side, dislodgement or accidental loss, occlusion or sheathing of the catheter, and groin pain [1, 3]. We describe the rare complication of an ascending colon perforation during implantation of a tunneled peritoneal drainage catheter in a patient with refractory ascites due to cirrhosis of the liver.
Case presentation The 68-year-old male was admitted to the intensive care unit with severe community acquired pneumonia. Because of rapidly progressing respiratory failure he
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