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.
Pinto et al. (Mon,) studied this question.