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- Title
DIFERENCIJALNA DIJAGNOZA PERITONITISA U BOLESNIKA NA PERITONEJSKOJ DIJALIZI.
- Authors
MIKOLAŠEVIĆ, IVANA; ORLIĆ, LIDIJA; JELIĆ, ITA; COLIĆ, MARINA; MURGIĆ, ENOLA; ANIĆ, KATA; GUDELJ, MIODRAG; DEVČIĆ, BOSILJKA; BAZDULJ, EDO; RUBČIĆ, IVANA; RAČKI, SANJIN
- Abstract
Peritoneal dialysis (PD) is a well-established method for the integrated care of end-stage renal disease. Peritonitis is a common complication of peritoneal dialysis (PD). Peritonitis is associated with significant morbidity, catheter loss, and transfer to hemodialysis, transient loss of ultrafiltration, possible permanent membrane damage and occasionally death. Namely, around 18% of the infection-related mortality in PD patients is the result of peritonitis. Although less than 4% of peritonitis episodes result in death, peritonitis is a "contributing factor" to death in 16% of deaths on PD. In addition, severe and prolonged peritonitis can lead to peritoneal membrane failure and peritonitis is probably the most common cause of technique failure in PD. Peritonitis remains a major cause of patients discontinuing PD and switching to hemodialysis. Conditions that may lead to secondary peritonitis include cholecystitis, appendicitis, ruptured diverticulum as well as treatment of severe constipation, perforation during endoscopy, bowel ischemia and incarcerated hernia. Secondary peritonitis is less common than PD-related peritonitis. Hereby, we report a case of a 60-years-old women referred to our Centre because of abdominal pain who had been treated with automated peritoneal dialysis (APD) since April 2014. In July 2014, patient was admitted to our emergency department with a history of sudden onset, severe abdominal pain, radiating to the back, nausea/vomiting, diarrhea and fever. Four days before the admission the pain was mild and diffuse, without other symptoms. Results of her physical examination identified a heart rate of 110 beats/min and diffuse tenderness of abdomen. The laboratory evaluation was unremarkable. A peripheral leukocytosis was 11,000/mm³' C-reactive protein was 8,4 mg/L. The dialysate white cell count was 7,4/mm3. The amylase concentration in dialysate was not elevated, although she was using icodextrin solutions. Abdominal radiogram revealed a small amounts of free intraperitoneal air. In further evaluation, we consulted with a surgeon who perormed a laparotomy. The cause of peritonitis was spleen perforation which led to a splenectomy. In everyday clinical practice the differential diagnosis among primary and secondary peritonitis in PD patients is often difficult. It is important to distinguish between these two conditions due to the fact that in most cases of secondary peritonitis surgical treatment is needed. Clinical outcome is much worse in cases of secondary peritonitis.
- Publication
Acta Medica Croatica, 2014, Vol 68, p168
- ISSN
1330-0164
- Publication type
Article