Peritoneal dialysis-related peritonitis complicated with nonocclusive mesenteric ischemia
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CASE REPORT
Peritoneal dialysis‑related peritonitis complicated with nonocclusive mesenteric ischemia Yasuhiro Oda1 · Kunihiro Ishioka1 · Hidekazu Moriya1 · Shinya Taguchi1 · Rikako Oki1 · Kenji Matsui1 · Yasuhiro Mochida1 · Sumi Hidaka1 · Takayasu Ohtake1 · Shuzo Kobayashi1 Received: 17 May 2020 / Accepted: 11 August 2020 © Japanese Society of Nephrology 2020
Abstract Peritoneal dialysis (PD)-related peritonitis is a common complication of PD. Nonocclusive mesenteric ischemia (NOMI) is a rare complication of PD-related peritonitis, has a high mortality rate, and therefore should be detected early once it occurs. We describe a case of a 70-year-old woman on PD presented with moderate abdominal pain and low blood pressure, which contributed to the early diagnosis of PD-related peritonitis complicated with NOMI. Increased white cell count of 7150/ μL (neutrophil, 84%) in dialysate effluent was diagnostic of PD-related peritonitis, which was later found to be caused by Pseudomonas putida. Computed tomography with contrast performed after administering crystalloids revealed hepatic portal venous gas, pneumatosis intestinalis in the ascending colon, and normal enhancement of the bowel wall and mesenteric arteries, which suggested a reperfusion of the previously ischemic ascending colon. Colonoscopy on hospital day seventeen revealed mucosal hemorrhage and ulcers in the entire right colon and the terminal ileum while the remaining colon was normal. These findings are compatible with the consequence of NOMI. Increased peak systolic velocity of the superior mesenteric artery (SMA) implied its stenosis. Past studies show that ischemia of the colon in patients with chronic kidney disease commonly occurs in the right colon. Arteriosclerosis of the SMA due to the long history of chronic kidney disease and diabetes might have caused its vulnerability to low blood pressure. Abdominal complications including NOMI should be screened for when a patient presents with low blood pressure and strong abdominal pain. This is the first case report that shows colonoscopy images of the colonic ulcers post-NOMI and PD-related peritonitis. Keywords Peritoneal dialysis · Peritonitis · Nonocclusive mesenteric ischemia · Hepatic portal venous gas · Superior mesenteric artery · Diabetic nephropathy
Introduction
Case report
Although peritoneal dialysis (PD)-related peritonitis is a common complication in patients on PD, PD-related peritonitis is rarely complicated with nonocclusive mesenteric ischemia (NOMI). Herein, we present a case of PD-related peritonitis presented with moderate abdominal pain and low blood pressure, which led to an early detection of NOMI that was later confirmed with computed tomography (CT) and colonoscopy, and discuss its etiology with a review of literature.
A 70-year-old woman with type 2 diabetes mellitus, chronic kidney disease (CKD) due to diabetic nephropathy, hypertension and dyslipidemia presented to our emergency department with twelve days of diarrhea and two days of worsening abdominal pain. She had st
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